Department of Surgery, Yonsei University College of Medicine, C.P.O. Box 8044, 250 Seongsanno, Seodaemun-gu, Seoul, 120-752, South Korea.
Surg Endosc. 2009 Nov;23(11):2399-406. doi: 10.1007/s00464-009-0366-x. Epub 2009 Mar 5.
Various robotic surgical procedures have been performed in recent years, and most reports have proved that the application of robotic technology for surgery is technically feasible and safe. This study aimed to introduce the authors' technique of robot-assisted endoscopic thyroid surgery and to demonstrate its applicability in the surgical management of thyroid cancer.
From 4 October 2007 through 14 March 2008, 100 patients with papillary thyroid cancer underwent robot-assisted endoscopic thyroid surgery using a gasless transaxillary approach. This novel robotic surgical approach allowed adequate endoscopic access for thyroid surgeries. All the procedures were completed successfully using the da Vinci S surgical robot system. Four robotic arms were used with this system: a 12-mm telescope and three 8-mm instruments. The three-dimensional magnified visualization obtained by the dual-channel endoscope and the tremor-free instruments controlled by the robotic systems allowed surgeons to perform sharp and precise endoscopic dissections.
Ipsilateral central compartment node dissection was used for 84 less-than-total and 16 total thyroidectomies. The mean operation time was 136.5 min (range, 79-267 min). The actual time for thyroidectomy with lymphadenectomy (console time) was 60 min (range, 25-157 min). The average number of lymph nodes resected was 5.3 (range, 1-28). No serious complications occurred. Most of the patients could return home within 3 days after surgery.
The technique of robot-assisted endoscopic thyroid surgery using a gasless transaxillary approach is a feasible, safe, and effective method for selected patients with thyroid cancer. The authors suggest that application of robotic technology for endoscopic thyroid surgeries could overcome the limitations of conventional endoscopic surgeries in the surgical management of thyroid cancer.
近年来已开展了多种机器人手术，大多数报道证实机器人技术在外科手术中的应用在技术上是可行和安全的。本研究旨在介绍作者的机器人辅助内镜甲状腺手术技术，并展示其在甲状腺癌外科治疗中的适用性。
从 2007 年 10 月 4 日至 2008 年 3 月 14 日，100 例甲状腺癌患者采用经腋窝无气腔入路的机器人辅助内镜甲状腺手术。这种新的机器人手术方法为甲状腺手术提供了足够的内镜通道。所有手术均成功完成达芬奇 S 外科机器人系统。该系统使用四个机器人臂：一个 12mm 望远镜和三个 8mm 器械。双通道内窥镜获得的三维放大可视化和由机器人系统控制的无震颤器械使外科医生能够进行精确的内镜解剖。
84 例次甲状腺部分切除术和 16 例次甲状腺全切除术行同侧中央区淋巴结清扫术。平均手术时间为 136.5 分钟（79-267 分钟）。甲状腺切除术和淋巴结切除术的实际时间（控制台时间）为 60 分钟（25-157 分钟）。切除的平均淋巴结数为 5.3 个（1-28 个）。无严重并发症发生。大多数患者术后 3 天内可回家。
经腋窝无气腔入路的机器人辅助内镜甲状腺手术技术是一种可行、安全、有效的方法，适用于选择的甲状腺癌患者。作者认为，机器人技术在内镜甲状腺手术中的应用可以克服传统内镜手术在甲状腺癌外科治疗中的局限性。
