Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea.
Surgery. 2010 Dec;148(6):1214-21. doi: 10.1016/j.surg.2010.09.016.
Since the introduction of endoscopic techniques in thyroid surgery, several trials of endoscopic lateral neck dissection have been conducted with the aim of avoiding a long cervical scar, but these endoscopic procedures require more effort than open surgery, mainly because of the relatively nonsophisticated instruments used. However, the recent introduction of surgical robotic systems has simplified the operations and increased the precision of endoscopic techniques. We have described our initial experience with robot-assisted modified radical neck dissection (MRND) in thyroid cancer using the da Vinci S system.
From October 2007 to October 2009, 33 patients with thyroid cancer with lateral neck lymph node (LN) metastases underwent robot-assisted thyroidectomy and additional robotic MRND using a gasless, transaxillary approach. Clinicopathologic data were analyzed retrospectively.
Mean patient age was 37 ± 9 years and the gender ratio (male to female) was 7:26. The mean operating time was 281 ± 41 minutes and mean postoperative hospital stay was 5.4 ± 1.6 days. The mean tumor size was 1.1 ± 0.5 cm and 20 cases (61%) had papillary thyroid microcarcinoma. The mean number of retrieved LNs was 6.1 ± 4.4 in the central neck compartment and 27.7 ± 11.0 in the lateral compartment. No serious postoperative complications, such as Horner's syndrome or major nerve injury, occurred.
Robot-assisted MRND is technically feasible, safe, and produces excellent cosmetic results. Based on our initial experience, robot-assisted MRND should be viewed as an acceptable alternative method in patients with low-risk, well-differentiated thyroid cancer with lateral neck node metastasis.
自从内镜技术应用于甲状腺手术以来，已经开展了多项内镜侧颈部清扫术的临床试验，旨在避免长的颈部疤痕，但这些内镜手术比开放手术需要更多的努力，主要是因为使用的器械相对不复杂。然而，最近外科机器人系统的引入简化了操作，提高了内镜技术的精度。我们已经描述了使用达芬奇 S 系统进行的机器人辅助改良根治性颈淋巴结清扫术（MRND）在甲状腺癌中的初步经验。
从 2007 年 10 月至 2009 年 10 月，33 例侧颈部淋巴结（LN）转移的甲状腺癌患者采用无气、经腋窝入路的机器人辅助甲状腺切除术和额外的机器人 MRND。回顾性分析临床病理资料。
患者平均年龄为 37 ± 9 岁，男女比例为 7:26。平均手术时间为 281 ± 41 分钟，平均术后住院时间为 5.4 ± 1.6 天。平均肿瘤大小为 1.1 ± 0.5cm，20 例（61%）为甲状腺乳头状微小癌。中央颈部间隙中取出的 LN 平均数量为 6.1 ± 4.4，外侧间隙为 27.7 ± 11.0。无严重术后并发症，如霍纳综合征或大神经损伤。
机器人辅助 MRND 技术上是可行的、安全的，并产生了极好的美容效果。根据我们的初步经验，机器人辅助 MRND 应该被视为低危、分化良好的甲状腺癌伴侧颈部淋巴结转移患者的一种可接受的替代方法。
