title: Comparing transaxillary robotic thyroidectomy with conventional surgery in a UK population: A case control study.
abstract: BACKGROUND
  Transaxillary robotic thyroid surgery was pioneered in South Korea where cultural factors, anthropometry and remuneration favour this. Small thyroid nodules account for the majority of cases due to a national thyroid cancer screening programme. However, the technique has not been evaluated in the United Kingdom where larger thyroid nodules tend to undergo surgery in a patient population with a higher body mass index (BMI).
  
  
  METHODS
  Long term prospective non-randomised study. Sixteen consecutive robotic hemithyroidectomy patients were compared to 16 open controls.
  
  
  RESULTS
  There were no robotic conversions to open and no significant difference regarding pain, voice, or quality of life (QoL). In the robotic group, long term. scar cosmesis at 3 years was superior (p = 0.02) although the operative time was significantly longer (228 min vs. 85 min, p = 0.01). One patient had a transient recurrent laryngeal nerve paresis and another had temporary shoulder dysfunction. Both resolved in 4 weeks.
  
  
  CONCLUSIONS
  This study highlights the considerable difference between a Western patient population compared to South East Asia. Despite this robotic thyroidectomy is feasible and safe in a UK population.
  
  
  CONCLUSIONS
  Despite a low uptake in the UK compared to the Far East, robotic thyroidectomy represents a viable option for selected patients, achieving superior cosmesis compared with conventional thyroidectomy at the expense of time and cost. The key is careful patient selection. A randomised study is needed to establish the clinical efficacy compared to conventional surgery in this population.
authors.affiliation: Department of Otorhinolaryngology and Head & Neck Surgery, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK. Electronic address: asitarora@doctors.org.uk.
authors.forename: Asit
authors.initials: A
authors.lastname: Arora
authors.affiliation: Department of Otorhinolaryngology and Head & Neck Surgery, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK.
authors.forename: George
authors.initials: G
authors.lastname: Garas
authors.affiliation: Department of Otorhinolaryngology and Head & Neck Surgery, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK.
authors.forename: Sunil
authors.initials: S
authors.lastname: Sharma
authors.affiliation: Department of Otorhinolaryngology and Head & Neck Surgery, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK.
authors.forename: Keerthini
authors.initials: K
authors.lastname: Muthuswamy
authors.affiliation: Department of Otorhinolaryngology and Head & Neck Surgery, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK.
authors.forename: James
authors.initials: J
authors.lastname: Budge
authors.affiliation: Department of Endocrine and Thyroid Surgery, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK.
authors.forename: Fausto
authors.initials: F
authors.lastname: Palazzo
authors.affiliation: Department of Biosurgery and Surgical Technology, St. Mary's Hospital, Imperial College London, London, UK.
authors.forename: Ara
authors.initials: A
authors.lastname: Darzi
authors.affiliation: Department of Otorhinolaryngology and Head & Neck Surgery, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK.
authors.forename: Neil
authors.initials: N
authors.lastname: Tolley
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D016022:Case-Control Studies; D002921:Cicatrix; D003431:Cross-Cultural Comparison; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology*; D011446:Prospective Studies; D011788:Quality of Life; D056910:Republic of Korea / Q000208:ethnology; D065287:Robotic Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D016606:Thyroid Nodule / Q000601:surgery*; D013965:Thyroidectomy / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome; D006113:United Kingdom / Q000208:ethnology
keywords: Anthropometry; Cosmesis; Endocrine surgery; Follow-up; Outcomes; Robotic; Scar; Thyroid; Transaxillary