Abstract
Thyroid surgery has recently seen a number of important advances. The latest addition to the armamentarium of head and neck and thyroid surgeons relates to remote-access robotic thyroidectomy. Robotic assistance overcomes the technical limitations associated with conventional endoscopic surgery and obviates the need for a neck scar, the primary limitation of video-assisted thyroidectomy. With robotic assistance, ergonomics and visualisation are greatly enhanced, thus permitting the translocation of the scar to a remote, ‘hidden’ area. Various approaches have been described utilising the transaxillary, facelift and transoral routes. Each has its own advantages and limitations; none is overwhelmingly superior. The most widely employed technique relates to transaxillary robotic thyroidectomy, for which there is now evidence to support its safety, feasibility and superior cosmesis without compromising outcomes in selected patients.
This chapter presents a step-by-step, detailed pictorial narrative of the surgical technique for transaxillary robotic thyroidectomy and discusses important topics around this novel procedure, including preoperative considerations and patient selection, informed consent, surgical complications unique to this approach and how to manage them, as well as training and credentialing in robotic thyroid surgery.
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References
Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016;26:1–133.
Perros P, Boelaert K, Colley S, Evans C, Evans RM, Gerrard Ba G, et al. Guidelines for the management of thyroid cancer. Clin Endocrinol. 2014;81(Suppl 1):1–122.
Russell JO, Noureldine SI, Al Khadem MG, Tufano RP. Minimally invasive and remote-access thyroid surgery in the era of the 2015 American Thyroid Association guidelines. Laryngoscope Investig Otolaryngol. 2016;1:175–9.
Arora A, Swords C, Garas G, Chaidas K, Prichard A, Budge J, et al. The perception of scar cosmesis following thyroid and parathyroid surgery: a prospective cohort study. Int J Surg. 2016;25:38–43.
Arora A, Garas G, Sharma S, Muthuswamy K, Budge J, Palazzo F, et al. Comparing transaxillary robotic thyroidectomy with conventional surgery in a UK population: a case control study. Int J Surg. 2016;27:110–7.
Sun GH, Peress L, Pynnonen MA. Systematic review and meta-analysis of robotic vs conventional thyroidectomy approaches for thyroid disease. Otolaryngol Head Neck Surg. 2014;150:520–32.
Tolley N, Garas G, Palazzo F, Prichard A, Chaidas K, Cox J, et al. Long-term prospective evaluation comparing robotic parathyroidectomy with minimally invasive open parathyroidectomy for primary hyperparathyroidism. Head Neck. 2016;38(Suppl 1):E300–6.
Kim MJ, Nam KH, Lee SG, Choi JB, Kim TH, Lee CR, et al. Yonsei experience of 5000 gasless transaxillary robotic thyroidectomies. World J Surg. 2018;42:393–401.
Garas G, Arora A, Tolley N. Robotic surgery of the parathyroid glands. In: Grillone GA, Jalisi S, editors. Robotic surgery of the head and neck: a comprehensive guide. New York: Springer; 2015. p. 133–46.
Garas G, Darzi A, Arora A, Tolley N. Single-port tranasaxillary robotic parathyroidectomy. In: Gil Z, Amit M, Kupferman ME, editors. Atlas of head and neck robotic surgery. New York: Springer; 2017. p. 93–106.
Garas G, Markar SR, Malietzis G, Ashrafian H, Hanna GB, Zacharakis E, et al. Induced bias due to crossover within randomized controlled trials in surgical oncology: a meta-regression analysis of minimally invasive versus open surgery for the treatment of gastrointestinal cancer. Ann Surg Oncol. 2018;25:221–30.
Garas G, Holsinger FC, Grant DG, Athanasiou T, Arora A, Tolley N. Is robotic parathyroidectomy a feasible and safe alternative to targeted open parathyroidectomy for the treatment of primary hyperparathyroidism? Int J Surg. 2015;15:55–60.
Tolley N, Arora A, Palazzo F, Garas G, Dhawan R, Cox J, Darzi A. Robotic-assisted parathyroidectomy: a feasibility study. Otolaryngol Head Neck Surg. 2011;144:859–66.
Chung WY. Pros of robotic transaxillary thyroid surgery: its impact on cancer control and surgical quality. Thyroid. 2012;22:986–7.
Kang SW, Jeong JJ, Yun JS, Sung TY, Lee SC, Lee YS, et al. Robot-assisted endoscopic surgery for thyroid cancer: experience with the first 100 patients. Surg Endosc. 2009;23:2399–406.
Foley CS, Agcaoglu O, Siperstein AE, Berber E. Robotic transaxillary endocrine surgery: a comparison with conventional open technique. Surg Endosc. 2012;26:2259–66.
Henry JF, Defechereux T, Gramatica L, de Boissezon C. Minimally invasive videoscopic parathyroidectomy by lateral approach. Langenbecks Arch Surg. 1999;384:298–301.
Pelizzo MR, Toniato A, Briguglio E. Lateral access in thyroidectomy. Technique and indications. Minerva Chir. 1993;48:189–91.
Garas G, Okabayashi K, Ashrafian H, Shetty K, Palazzo F, Tolley N, et al. Which hemostatic device in thyroid surgery? A network meta-analysis of surgical technologies. Thyroid. 2013;23:1138–50.
Meltzer C, Klau M, Gurushanthaiah D, Tsai J, Meng D, Radler L, Sundang A. Surgeon volume in thyroid surgery: surgical efficiency, outcomes, and utilization. Laryngoscope. 2016;126:2630–9.
Sosa JA, Bowman HM, Tielsch JM, Powe NR, Gordon TA, Udelsman R. The importance of surgeon experience for clinical and economic outcomes from thyroidectomy. Ann Surg. 1998;228:320–30.
Athanasiou T, Patel V, Garas G, Ashrafian H, Hull L, Sevdalis N, et al. Mentoring perception, scientific collaboration and research performance: is there a ‘gender gap’ in academic medicine? An academic health science centre perspective. Postgrad Med J. 2016;92:581–6.
Athanasiou T, Patel V, Garas G, Ashrafian H, Shetty K, Sevdalis N, et al. Mentoring perception and academic performance: an academic health science centre survey. Postgrad Med J. 2016;92:597–602.
Santok GD, Raheem AA, Kim LH, Chang K, Chung BH, Choi YD, Rha KH. Proctorship and mentoring: its backbone and application in robotic surgery. Investig Clin Urol. 2016;57(Suppl 2):S114–20.
Schreuder HW, Wolswijk R, Zweemer RP, Schijven MP, Verheijen RH. Training and learning robotic surgery, time for a more structured approach: a systematic review. BJOG. 2012;119:137–49.
Requirements for credentialing of robotic surgeons. Epworth Healthcare. Victoria, Australia. 2015. http://www.epworth.org.au/Our-Services/Robotic-Surgery/Documents/Epworth%20Robotic%20Credentialing%20revised%202015.pdf. Accessed 22 July 2019.
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Garas, G., Timon, C., Tolley, N. (2024). Video-Assisted and Robotic Thyroidectomy. In: Simo, R., Pracy, P., Fernandes, R. (eds) Atlas of Head and Neck Surgery . Springer Surgery Atlas Series. Springer, Cham. https://doi.org/10.1007/978-3-031-36593-5_47
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