Comparative Study between Robotic Total Thyroidectomy with Central Lymph Node Dissection via Bilateral Axillo-breast Approach and Conventional Open Procedure for Papillary Thyroid Microcarcinoma.
BACKGROUND
A large proportion of the patients with papillary thyroid microcarcinoma are young women. Therefore, minimally invasive endoscopic thyroidectomy with central neck dissection (CND) emerged and showed well-accepted results with improved cosmetic outcome, accelerated healing, and comforting the patients. This study aimed to evaluate the safety and effectiveness of robotic total thyroidectomy with CND via bilateral axillo-breast approach (BABA), compared with conventional open procedure in papillary thyroid microcarcinoma.


METHODS
One-hundred patients with papillary thyroid microcarcinoma from March 2014 to January 2015 in Jinan Military General Hospital of People's Liberation Army (PLA) were randomly assigned to robotic group or conventional open approach group (n = 50 in each group). The total operative time, estimated intraoperative blood loss, numbers of lymph node removed, visual analog scale (VAS), postoperative hospital stay time, complications, and numerical scoring system (NSS, used to assess cosmetic effect) were analyzed.


RESULTS
The robotic total thyroidectomy with CND via BABA was successfully performed in robotic group. There were no conversion from the robotic surgeries to open or endoscopic surgery. The subclinical central lymph node metastasis rate was 35%. The mean operative time of the robotic group was longer than that of the conventional open approach group (118.8 ± 16.5 min vs. 90.7 ± 10.3 min, P < 0.05). The study showed significant differences between the two groups in terms of the VASs (2.1 ± 1.0 vs. 3.8 ± 1.2, P < 0.05) and NSS (8.9 ± 0.8 vs. 4.8 ± 1.7, P < 0.05). The differences between the two groups in the estimated intraoperative blood loss, postoperative hospital stay time, numbers of lymph node removed, postoperative thyroglobulin levels, and complications were not statistically significant (all P > 0.05). Neither iatrogenic implantation nor metastasis occurred in punctured porous channel or chest wall in both groups. Postoperative cosmetic results were very satisfactory in the robotic group.


CONCLUSIONS
Robotic total thyroidectomy with CND via BABA is safe and effective for Chinese patients with papillary thyroid microcarcinoma who worry about the neck scars.
Department of Thyroid and Parathyroid Surgery, Jinan Military General Hospital of People's Liberation Army, Jinan, Shandong 250031, China.
Qing-Qing
QQ
He
Department of Thyroid and Parathyroid Surgery, Jinan Military General Hospital of People's Liberation Army, Jinan, Shandong 250031, China.
Jian
J
Zhu
Department of Thyroid and Parathyroid Surgery, Jinan Military General Hospital of People's Liberation Army, Jinan, Shandong 250031, China.
Da-Yong
DY
Zhuang
Department of Thyroid and Parathyroid Surgery, Jinan Military General Hospital of People's Liberation Army, Jinan, Shandong 250031, China.
Zi-Yi
ZY
Fan
Department of Thyroid and Parathyroid Surgery, Jinan Military General Hospital of People's Liberation Army, Jinan, Shandong 250031, China.
Lu-Ming
LM
Zheng
Department of Thyroid and Parathyroid Surgery, Jinan Military General Hospital of People's Liberation Army, Jinan, Shandong 250031, China.
Peng
P
Zhou
Department of Thyroid and Parathyroid Surgery, Jinan Military General Hospital of People's Liberation Army, Jinan, Shandong 250031, China.
Lei
L
Hou
Department of Thyroid and Parathyroid Surgery, Jinan Military General Hospital of People's Liberation Army, Jinan, Shandong 250031, China.
Fang
F
Yu
Department of Thyroid and Parathyroid Surgery, Jinan Military General Hospital of People's Liberation Army, Jinan, Shandong 250031, China.
Yan-Ning
YN
Li
Department of Thyroid and Parathyroid Surgery, Jinan Military General Hospital of People's Liberation Army, Jinan, Shandong 250031, China.
Lei
L
Xiao
Department of Thyroid and Parathyroid Surgery, Jinan Military General Hospital of People's Liberation Army, Jinan, Shandong 250031, China.
Xue-Feng
XF
Dong
Department of Thyroid and Parathyroid Surgery, Jinan Military General Hospital of People's Liberation Army, Jinan, Shandong 250031, China.
Gao-Feng
GF
Ni
D000328:Adult; D002291:Carcinoma, Papillary / Q000097:blood / Q000601:surgery*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D061646:Operative Time; D011184:Postoperative Period; D065287:Robotic Surgical Procedures / Q000379:methods*; D013954:Thyroglobulin / Q000097:blood; D013964:Thyroid Neoplasms / Q000097:blood / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods*
D013954:Thyroglobulin