title: A systematic review and meta-analysis evaluating completeness and outcomes of robotic thyroidectomy.
abstract: OBJECTIVE
  Despite immense interest, robotic-assisted thyroidectomy (RT) remains controversial in differentiated thyroid carcinoma (DTC). This systematic review and meta-analysis compared surgical completeness and/or oncological outcomes between RT and open thyroidectomy (OT) in low-risk DTC.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  A systematic review was performed to identify studies that compared surgical completeness and/or oncological outcomes between RT and OT in DTC. Any study that compared at least one parameter relating to surgical completeness and/or oncological outcome for DTC was considered. Number of central lymph nodes (CLNs) retrieved during central neck dissection (CND), preablation stimulated thyroglobulin (sTg) level, radioiodine uptake on post-therapy scan, and locoregional recurrence (LRR) were examined. Meta-analysis was performed using a fixed or random-effects model depending on heterogeneity between studies.
  
  
  RESULTS
  Ten studies were eligible. Of the 2,205 DTCs, 752 (34.1%) had RT, whereas 1,453 (65.9%) had OT. Relative to OT, RT had significantly fewer CLNs retrieved during CND (4.7 ± 3.2 vs. 5.5 ± 3.8, standardized mean difference [SMD] = -0.240, 95% confidence interval [CI]: -0.364 to -0.116, P < .001) and higher preablation sTg level (3.6 ± 6.7 ng/mL vs. 2.0 ± 5.0 ng/mL, SMD = 0.272, 95% CI: 0.022 to 0.522, P = .033). Interestingly, these differences were more evident in the robotic transaxillary approach (RTAA) than the robotic bilateral axillo-breast approach. After a mean follow-up of 17.7 months, no LRR was found in RT, whereas after 18.6 months, one LRR was found in OT.
  
  
  CONCLUSIONS
  Relative to OT, total thyroidectomy by RTAA was associated with fewer CLNs retrieved and less-complete thyroid resection. However, using RTAA is unlikely to compromise the outcomes of low-risk DTC because of its inherently good prognosis.
authors.affiliation: Department of Surgery, University of Hong Kong, Hong Kong, China.
authors.forename: Brian Hung-Hin
authors.initials: BH
authors.lastname: Lang
authors.forename: Carlos K H
authors.initials: CK
authors.lastname: Wong
authors.forename: Julian S
authors.initials: JS
authors.lastname: Tsang
authors.forename: Kai P
authors.initials: KP
authors.lastname: Wong
authors.forename: Koon Y
authors.initials: KY
authors.lastname: Wan
mesh_terms: D006801:Humans; D009364:Neoplasm Recurrence, Local; D010043:Outcome and Process Assessment, Health Care; D012371:Robotics; D013964:Thyroid Neoplasms / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods*
keywords: Robotic thyroidectomy; central lymph nodes; papillary thyroid carcinoma; radioactive iodine; thyroglobulin; total thyroidectomy