Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA.
Ann Surg Oncol. 2012 Apr;19(4):1269-74. doi: 10.1245/s10434-011-2075-7. Epub 2011 Nov 8.
The purpose of this study was to compare the outcome of robot-assisted transaxillary thyroid surgery (RATS) to the standard open technique for thyroid lobectomy in the U.S. population.
Comparison was made between 25 consecutive patients who underwent thyroid lobectomy via RATS and 25 patients who underwent open thyroid lobectomy. All patients met predetermined criteria for RATS. Clinical characteristics of patients and operative data were compared between groups using the Fisher exact or the Kruskal-Wallis test.
The RATS and open groups were similar in gender (92% vs 84% female), median body mass index (BMI) (25 vs 26), preoperative cytology (P=.71), and postoperative diagnosis (P=.91). Operative time for the RATS group was longer than the open group [median 121 minutes (range 74-199 minutes) vs 68 minutes (41-112 minutes), P<.0001]. Estimated blood loss was greater in the RATS group [median 10 cc (0-150 cc) vs 0 cc (0-25 cc), P=.0042]. Unlike the open group, postoperative complications in the RATS group included 2 patients with neurological deficits in the brachial plexus distribution. The postoperative incidence of temporary hoarseness, bleeding, infection, seroma, numbness, and length of hospital stay did not differ significantly between groups.
In a select group of patients, RATS is comparable to open thyroid lobectomy in terms of postoperative complications and hospital stay. Patients should be counseled that RATS is associated with a longer operative time, a potential for brachial plexus neurological deficits, and larger (although still low) blood loss. A prospective trial further evaluating cost, quality of life, and patient-reported satisfaction is warranted.
本研究旨在比较美国人群中机器人辅助经腋窝甲状腺手术（RATS）与标准开放甲状腺叶切除术的治疗结果。
比较了 25 例连续接受 RATS 甲状腺叶切除术的患者和 25 例接受开放甲状腺叶切除术的患者。所有患者均符合 RATS 的预定标准。使用 Fisher 确切检验或 Kruskal-Wallis 检验比较两组患者的临床特征和手术数据。
RATS 组和开放组在性别（92% vs 84%女性）、中位体重指数（BMI）（25 vs 26）、术前细胞学检查（P=.71）和术后诊断（P=.91）方面相似。RATS 组的手术时间长于开放组[中位数 121 分钟（范围 74-199 分钟）vs 68 分钟（41-112 分钟），P<.0001]。RATS 组的估计出血量较大[中位数 10cc（0-150cc）vs 0cc（0-25cc），P=.0042]。与开放组不同，RATS 组术后并发症包括 2 例臂丛神经分布的神经功能缺损。两组患者的暂时性声音嘶哑、出血、感染、血清肿、麻木和住院时间无显著差异。
在一组选择的患者中，RATS 在术后并发症和住院时间方面与开放甲状腺叶切除术相当。应告知患者，RATS 与手术时间较长、臂丛神经损伤的潜在风险以及较大的（尽管仍较低）出血量有关。需要进一步进行前瞻性试验来评估成本、生活质量和患者报告的满意度。
