SpringerLink
Log in

Robotic thyroidectomy by bilateral axillo-breast approach: review of 1026 cases and surgical completeness

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Good postoperative and excellent cosmetic results have been achieved with bilateral axillo-breast approach (BABA) robotic thyroidectomy (RoT). This study was performed to analyze the surgical outcomes and evaluate the surgical completeness and safety of BABA RoT.

Methods

Between February 2008 and February 2012, a total of 1026 cases of BABA RoT were performed. The clinicopathologic characteristics, operation types, and postoperative outcomes of patients were analyzed.

Results

Of the 1026 cases analyzed, 968 cases were a malignant tumor and 58 cases were benign thyroid disease. Mean operating times for BABA total RoT with central lymph node dissection included 38 ± 13 min (range 20–90 min) of working space creation and 75 ± 26 min (range 25–175) of console time. Among the 872 patients who underwent total thyroidectomy with central lymph node dissection, transient hypoparathyroidism occurred in 39.1 %, transient vocal cord palsy occurred in 14.2 %, and permanent hypoparathyroidism and permanent vocal cord palsy occurred in 1.5 % and 0.2 % of patients, respectively. The median stimulated thyroglobulin (Tg) level of patients after their first radioactive iodine therapy was 0.4 ng/mL, with 65.1 % of patients having a stimulated Tg level of <1.0 ng/mL. The median suppressed Tg level at 3 postoperative months of patients without radioactive iodine therapy was <0.1 ng/mL, with 99.4 % of patients showing a suppressed Tg level of< 1.0 ng/mL. There was no recurrence or mortality after a median follow-up of 23 months.

Conclusions

BABA RoT is a safe and effective method that provides good surgical completeness and has low rates of postoperative complications and recurrence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM (2010) GLOBOCAN 2008 v2.0. Cancer incidence and mortality worldwide. IARC Cancer Base No. 10. International Agency for Research on Cancer, Lyon, France. Available at: http://globocan.iarc.fr. Accessed July 1, 2012

  2. Davies L, Welch HG (2006) Increasing incidence of thyroid cancer in the United States, 1973–2002. JAMA 295(18):2164–2167

    Article  PubMed  CAS  Google Scholar 

  3. Lee JS (2012) Cancer facts and figures. National Cancer Control Institute http://ncc.re.kr. Accessed July 1, 2012

  4. Kelly AP (2009) Update on the management of keloids. Semin Cutan Med Surg 28(2):71–76

    Article  PubMed  CAS  Google Scholar 

  5. Soltani AM, Francis CS, Motamed A, Karatsonyi AL, Hammoudeh JA, Sanchez-Lara PA, Reinisch JF, Urata MM (2012) Hypertrophic scarring in cleft lip repair: a comparison of incidence among ethnic groups. Clin Epidemiol 4:187–191

    PubMed  Google Scholar 

  6. Dionigi G (2009) Robotic thyroid surgery: need for initial stricter patient selection criteria. Surg Laparosc Endosc Percutan Tech 19(6):518

    Article  PubMed  Google Scholar 

  7. Lee KE, Koo DH, Im HJ, Park SK, Choi JY, Paeng JC, Chung JK, Oh SK, Youn YK (2011) Surgical completeness of bilateral axillo-breast approach robotic thyroidectomy: comparison with conventional open thyroidectomy after propensity score matching. Surgery 150(6):1266–1274

    Article  PubMed  Google Scholar 

  8. Lee KE, Koo DH, Kim SJ, Lee J, Park KS, Oh SK, Youn YK (2010) Outcomes of 109 patients with papillary thyroid carcinoma who underwent robotic total thyroidectomy with central node dissection via the bilateral axillo-breast approach. Surgery 148(6):1207–1213

    Article  PubMed  Google Scholar 

  9. Lee KE, Choi JY, Youn YK (2011) Bilateral axillo-breast approach robotic thyroidectomy. Surg Laparosc Endosc Percutan Tech 21(4):230–236

    Article  PubMed  Google Scholar 

  10. Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, Mazzaferri EL, Mciver B, Pacini F, Schlumberger M, Sherman SI, Steward DL, Tuttle RM (2009) Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 19(11):1167–1214

    Article  PubMed  Google Scholar 

  11. Lee KE, Rao J, Youn YK (2009) Endoscopic thyroidectomy with the da Vinci robot system using the bilateral axillary breast approach (BABA) technique: our initial experience. Surg Laparosc Endosc Percutan Tech 19(3):e71–e75

    Article  PubMed  Google Scholar 

  12. Gagner M (1996) Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism. Br J Surg 83(6):875

    Article  PubMed  CAS  Google Scholar 

  13. Shimazu K, Shiba E, Tamaki Y, Takiguchi S, Taniguchi E, Ohashi S, Noguchi S (2003) Endoscopic thyroid surgery through the axillo-bilateral-breast approach. Surg Laparosc Endosc Percutan Tech 13(3):196–201

    Article  PubMed  Google Scholar 

  14. Choe JH, Kim SW, Chung KW, Park KS, Han WS, Noh DY, Oh SK, Youn YK (2007) Endoscopic thyroidectomy using a new bilateral axillo-breast approach. World J Surg 31(3):601–606

    Article  PubMed  Google Scholar 

  15. Kang SW, Jeong JJ, Nam KH, Chang HS, Chung WY, Park CS (2009) Robot-assisted endoscopic thyroidectomy for thyroid malignancies using a gasless transaxillary approach. J Am Coll Surg 209(2):e1–e7

    Article  PubMed  Google Scholar 

  16. Tan CTK, Cheah WK, Delbridge L (2008) “Scarless” (in the neck) endoscopic thyroidectomy (SET): an evidence-based review of published techniques. World J Surg 32(7):1349–1357

    Article  PubMed  Google Scholar 

  17. Slotema ET, Sebag F, Henry JF (2008) What is the evidence for endoscopic thyroidectomy in the management of benign thyroid disease? World J Surg 32(7):1325–1332

    Article  PubMed  Google Scholar 

  18. Choi JY, Lee KE, Chung KW, Kim SW, Choe JH, Koo DH, Kim SJ, Lee J, Chung YS, Oh SK, Youn YK (2012) Endoscopic thyroidectomy via bilateral axillo-breast approach (BABA): review of 512 cases in a single institute. Surg Endosc 26(4):948–955

    Article  PubMed  Google Scholar 

  19. Tuttle RM, Ball DW, Byrd D, Dilawari RA, Doherty GM, Duh QY, Ehya H, Farrar WB, Haddad RI, Kandeel F, Kloos RT, Kopp P, Lamonica DM, Loree TR, Lydiatt WM, Mccaffrey JC, Olson JA, Parks L, Ridge JA, Shah JP, Sherman SI, Sturgeon C, Waguespack SG, Wang TN, Wirth LJ (2010) Thyroid carcinoma. J Natl Compr Canc Netw 8(11):1228–1274

    PubMed  Google Scholar 

  20. Torrens JI, Burch HB (2001) Serum thyroglobulin measurement. Utility in clinical practice. Endocrinol Metab Clin North Am 30(2):429–467

    Article  PubMed  CAS  Google Scholar 

  21. Miccoli P, Elisei R, Materazzi G, Capezzone M, Galleri D, Pacini F, Berti P, Pinchera A (2002) Minimally invasive video-assisted thyroidectomy for papillary carcinoma: a prospective study of its completeness. Surgery 132(6):1070–1073

    Article  PubMed  Google Scholar 

  22. Pacini F, Lari R, Mazzeo S, Grasso L, Taddei D, Pinchera A (1985) Diagnostic-value of a single serum thyroglobulin determination on and off thyroid suppressive therapy in the follow-up of patients with differentiated thyroid-cancer. Clin Endocrinol (Oxf) 23(4):405–411

    Article  CAS  Google Scholar 

  23. Mazzaferri EL, Kloos RT (2002) Is diagnostic iodine-131 scanning with recombinant human TSH useful in the follow-up of differentiated thyroid cancer after thyroid ablation? J Clin Endocrinol Metab 87(4):1490–1498

    Article  PubMed  CAS  Google Scholar 

  24. Schlumberger M, Catargi B, Borget I, Deandreis D, Zerdoud S, Bridji B, Bardet S, Leenhardt L, Bastie D, Schvartz C, Vera P, Morel O, Benisvy D, Bournaud C, Bonichon F, Dejax C, Toubert ME, Leboulleux S, Ricard M, Benhamou E, Refractaires TT (2012) Strategies of radioiodine ablation in patients with low-risk thyroid cancer. N Engl J Med 366(18):1663–1673

    Article  PubMed  CAS  Google Scholar 

  25. Wartofsky L (2002) Editorial: using baseline and recombinant human TSH-stimulated Tg measurements to manage thyroid cancer without diagnostic (131)I scanning. J Clin Endocrinol Metab 87(4):1486–1489

    Article  PubMed  CAS  Google Scholar 

  26. Cailleux AF, Baudin E, Travagli JP, Ricard M, Schlumberger M (2000) Is diagnostic iodine-131 scanning useful after total thyroid ablation for differentiated thyroid cancer? J Clin Endocrinol Metab 85(1):175–178

    Article  PubMed  CAS  Google Scholar 

  27. Grunwald F, Menzel C, Fimmers R, Zamora PO, Biersack HJ (1996) Prognostic value of thyroglobulin after thyroidectomy before ablative radioiodine therapy in thyroid cancer. J Nucl Med 37(12):1962–1964

    PubMed  CAS  Google Scholar 

  28. Kim TY, Kim WB, Kim ES, Ryu JS, Yeo JS, Kim SC, Hong SJ, Shong YK (2005) Serum thyroglobulin levels at the time of 131I remnant ablation just after thyroidectomy are useful for early prediction of clinical recurrence in low-risk patients with differentiated thyroid carcinoma. J Clin Endocrinol Metab 90(3):1440–1445

    Article  PubMed  CAS  Google Scholar 

  29. Mallick U, Harmer C, Yap B, Wadsley J, Clarke S, Moss L, Nicol A, Clark PM, Farnell K, Mccready R, Smellie J, Franklyn JA, John R, Nutting CM, Newbold K, Lemon C, Gerrard G, Abdel-Hamid A, Hardman J, Macias E, Roques T, Whitaker S, Vijayan R, Alvarez P, Beare S, Forsyth S, Kadalayil L, Hackshaw A (2012) Ablation with low-dose radioiodine and thyrotropin alfa in thyroid cancer. N Engl J Med 366(18):1674–1685

    Article  PubMed  CAS  Google Scholar 

  30. Lombardi CP, Raffaelli M, De Crea C, Princi P, Castaldi P, Spaventa A, Salvatori M, Bellantone R (2007) Report on 8 years of experience with video-assisted thyroidectomy for papillary thyroid carcinoma. Surgery 142(6):944–951

    Article  PubMed  Google Scholar 

  31. Lee S, Ryu HR, Park JH, Kim KH, Kang SW, Jeong JJ, Nam KH, Chung WY, Park CS (2011) Excellence in robotic thyroid surgery: a comparative study of robot-assisted versus conventional endoscopic thyroidectomy in papillary thyroid microcarcinoma patients. Ann Surg 253(6):1060–1066

    Article  PubMed  Google Scholar 

  32. Kang SW, Lee SC, Lee SH, Lee KY, Jeong JJ, Lee YS, Nam KH, Chang HS, Chung WY, Park CS (2009) Robotic thyroid surgery using a gasless, transaxillary approach and the da Vinci S system: the operative outcomes of 338 consecutive patients. Surgery 146(6):1048–1055

    Article  PubMed  Google Scholar 

  33. Kang SW, Lee SH, Ryu HR, Lee KY, Jeong JJ, Nam KH, Chung WY, Park CS (2010) Initial experience with robot-assisted modified radical neck dissection for the management of thyroid carcinoma with lateral neck node metastasis. Surgery 148(6):1214–1221

    Article  PubMed  Google Scholar 

  34. Tae K, Ji YB, Cho SH, Lee SH, Kim DS, Kim TW (2012) Early surgical outcomes of robotic thyroidectomy by a gasless unilateral axillo-breast or axillary approach for papillary thyroid carcinoma: 2 years’ experience. Head Neck 34(5):617–625

    Article  PubMed  Google Scholar 

  35. Chung YS, Choe JH, Kang KH, Kim SW, Chung KW, Park KS, Han W, Noh DY, Oh SK, Youn YK (2007) Endoscopic thyroidectomy for thyroid malignancies: comparison with conventional open thyroidectomy. World J Surg 31(12):2302–2308

    Article  PubMed  Google Scholar 

  36. Lee YS, Kim SW, Kim SW, Kim SK, Kang HS, Lee ES, Chung KW (2007) Extent of routine central lymph node dissection with small papillary thyroid carcinoma. World J Surg 31(10):1954–1959

    Article  PubMed  Google Scholar 

  37. Roh JL, Park JY, Il Park C (2007) Total thyroidectomy plus neck dissection in differentiated papillary thyroid carcinoma patients: pattern of nodal metastasis, morbidity, recurrence, and postoperative levels of serum parathyroid hormone. Ann Surg 245(4):604–610

    Google Scholar 

  38. Palestini N, Borasi A, Cestino L, Freddi M, Odasso C, Robecchi A (2008) Is central neck dissection a safe procedure in the treatment of papillary thyroid cancer? Our experience. Langenbecks Arch Surg 393(5):693–698

    Article  CAS  Google Scholar 

  39. Henry JF, Gramatica L, Denizot A, Kvachenyuk A, Puccini M, Defechereux T (1998) Morbidity of prophylactic lymph node dissection in the central neck area in patients with papillary thyroid carcinoma. Langenbecks Arch Surg 383(2):167–169

    Article  PubMed  CAS  Google Scholar 

  40. Sywak M, Comford L, Roach P, Stalberg P, Sidhu S, Delbridge L (2006) Routine ipsilateral level VI lymphadenectomy reduces postoperative thyroglobulin levels in papillary thyroid cancer. Surgery 140(6):1000–1005

    Article  PubMed  Google Scholar 

  41. Steinmuller T, Klupp J, Wenking S, Neuhaus P (1999) Complications associated with different surgical approaches to differentiated thyroid carcinoma. Langenbecks Arch Surg 384(1):50–53

    Article  PubMed  CAS  Google Scholar 

  42. Lee YS, Nam KH, Chung WY, Chang HS, Park CS (2010) Postoperative complications of thyroid cancer in a single center experience. J Korean Med Sci 25(4):541–545

    Article  PubMed  Google Scholar 

  43. Kim SJ, Lee KE, Myong JP, Kwon MR, Youn YK (2011) Recovery of sensation in the anterior chest area after bilateral axillo-breast approach endoscopic/robotic thyroidectomy. Surg Laparosc Endosc Percutan Tech 21(5):366–371

    Article  PubMed  Google Scholar 

  44. Masetti R, Di Leone A, Franceschini G, Magno S, Terribile D, Fabbri MC, Chiesa F (2006) Oncoplastic techniques in the conservative surgical treatment of breast cancer: an overview. Breast J 12(5):S174–S180

    Article  PubMed  Google Scholar 

  45. Baildam AD (2002) Oncoplastic surgery of the breast. Br J Surg 89(5):532–533

    Article  PubMed  CAS  Google Scholar 

Download references

Disclosures

Kyu Eun Lee, Eunyoung Kim, June Young Choi, Do Hoon Koo, Kyu Hyung Kim, and Yeo-Kyu Youn have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Department of Surgery, Seoul National University Hospital and College of Medicine, 101, Daehak-ro, Jongno-gu, 110-744, Seoul, South Korea

    Kyu Eun Lee, Eunyoung Kim, June Young Choi & Yeo-Kyu Youn

  2. Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea

    Kyu Eun Lee, Eunyoung Kim, Do Hoon Koo, June Young Choi & Yeo-Kyu Youn

  3. Division of Surgery, Thyroid Center, Seoul National University Cancer Hospital, Seoul, South Korea

    Kyu Eun Lee, Eunyoung Kim, June Young Choi & Yeo-Kyu Youn

  4. Department of Surgery, Seoul National University Boramae Medical Center and College of Medicine, Seoul, South Korea

    Do Hoon Koo

  5. Department of Surgery, Seoul National University Bundang Hospital, Seoul, South Korea

    Kyu Hyung Kim

Authors
  1. Kyu Eun Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eunyoung Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Do Hoon Koo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. June Young Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kyu Hyung Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yeo-Kyu Youn
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Eunyoung Kim or Yeo-Kyu Youn.

Additional information

The Kyu Eun Lee and Eunyoung Kim authors contributed equally to this work, and both should be considered first author.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lee, K.E., Kim, E., Koo, D.H. et al. Robotic thyroidectomy by bilateral axillo-breast approach: review of 1026 cases and surgical completeness. Surg Endosc 27, 2955–2962 (2013). https://doi.org/10.1007/s00464-013-2863-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-013-2863-1

Keywords

Search

Navigation