title: [Robotic thyroidectomy with central neck dissection using axillo-bilateral-breast approach: a comparison to open conventional approach].
abstract: OBJECTIVE
  To evaluate surgical outcomes and the feasibility of robotic thyroidectomy and central neck dissection (CND).
  
  
  METHODS
  The clinical data of 40 patients of papillary thyroid microcarcinoma underwent total thyroidectomy (or lobectomy and isthmusectomy) and CND using the Da Vinci system through axillo-bilateral-breast approach in Jinan Military General Hospital of People's Liberation Army from February to December 2014 were analyzed retrospectively (robotic group). Other forty patients of papillary thyroid microcarcinoma underwent total thyroidectomy (or lobectomy and isthmusectomy) and CND by open approach were selected as the control (open group). Cosmetic satisfaction was assessed after a month postoperation by the numerical score system. t-test and χ(2) test were used to compare the clinical characters, total operative time, intraoperative estimated blood loss, postoperative hospital stay, number of lymph nodes removed, visual analogue scale for pain, postoperative complications, and cosmetic effect between the 2 groups.
  
  
  RESULTS
  All 80 patients were diagnosed of papillary thyroid microcarcinoma. The total thyroidectomy (or lobectomy/isthmusectomy) with CND of 40 patients were successfully performed by da Vinci Si surgical system. The numbers of total thyroidectomy of robotic group and the open group were 36 and 37, respectively. The numbers of metastatic lymph nodes of robotic group and open group were 14 and 15, respectively. The operation time of the robotic group was (130±12) minutes, which was longer than that of open group (98±11) minutes (t=12.432, P<0.05). The study showed statistical significant difference between the two groups regarding the visual analog scale pain assessment (1.9±0.9 vs.3.9±1.1, t=8.900, P<0.05). There were no statistical significant difference of intraoperative estimated blood loss, postoperative hospital stay, number of lymph nodes removed, and the complication rate between the 2 groups.Postoperative cosmetic result was more satisfying on the robotic group (9.1±0.5) than open group (4.8±1.5) (t=17.200, P<0.05).
  
  
  CONCLUSIONS
  The robotic total thyroidectomy (or lobectomy and isthmusectomy) and CND has similar surgery safety and feasibility as open procedures. The robotic thyroidectomy is a good alternative surgical modality for patients with papillary thyroid microcarcinoma who wish to avoid neck scars.
authors.affiliation: Department of Thyroid and Parathyriod Surgery, Jinan Military General Hospital of People's Liberation Army, Jinan 250031, China.
authors.forename: Qingqing
authors.initials: Q
authors.lastname: He
authors.forename: Jian
authors.initials: J
authors.lastname: Zhu
authors.forename: Ziyi
authors.initials: Z
authors.lastname: Fan
authors.forename: Dayong
authors.initials: D
authors.lastname: Zhuang
authors.forename: Luming
authors.initials: L
authors.lastname: Zheng
authors.forename: Peng
authors.initials: P
authors.lastname: Zhou
authors.forename: Tao
authors.initials: T
authors.lastname: Yue
authors.forename: Fa
authors.initials: F
authors.lastname: Yu
authors.forename: Lei
authors.initials: L
authors.lastname: Hou
authors.forename: Xuefeng
authors.initials: X
authors.lastname: Dong
authors.forename: Yanning
authors.initials: Y
authors.lastname: Li
authors.forename: Gaofeng
authors.initials: G
authors.lastname: Ni
authors.forename: Haitao
authors.initials: H
authors.lastname: Zhang
mesh_terms: D001365:Axilla; D001940:Breast; D002291:Carcinoma, Papillary / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008198:Lymph Nodes; D037981:Neck Dissection; D061646:Operative Time; D011183:Postoperative Complications; D011184:Postoperative Period; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures; D013964:Thyroid Neoplasms / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods*