Department of Surgery, Division of Endocrine and Oncological Surgery, Tulane University School of Medicine, New Orleans, LA 70112, USA.
J Am Coll Surg. 2012 Apr;214(4):558-64; discussion 564-6. doi: 10.1016/j.jamcollsurg.2012.01.002. Epub 2012 Feb 22.
The influence of minimally invasive options has led to the application of new evolving techniques in thyroid surgery to eliminate visible neck scars. Here, we describe one author's experience with transaxillary robotic thyroidectomy and examine the effect of experience on determining the learning curve and improvements over time in operative performance.
With IRB approval, a prospective analysis of our surgical experience was performed. All patients underwent robotic transaxillary thyroidectomy by a single surgeon between September 2009 and June 2011. Principal outcomes measures included length of hospital stay, incidence of complications, and effect of obesity on outcomes.
One hundred consecutive operations were performed on 91 patients. Sixty-nine hemithyroidectomy, 22 total or near-total thyroidectomy, and 9 completion thyroidectomy procedures were performed. Of patients who underwent hemithyroidectomy, 21.7% were discharged within 4 hours; the remaining patients were discharged within 23 hours. Mean operative time for hemithyroidectomy was 108.1 ± 60.5 minutes, and for total or near-total thyroidectomy, mean operative time was 118.1 ± 51.3 minutes. Mean robot docking time was 9.1 ± 2.2 minutes for all cases. Obesity contributed to prolonged total operative time. Improvement in the length of time to perform components of the procedure was noted after 45 cases. Two cases required conversion to a cervical approach. There were no instances of permanent vocal cord palsy on postoperative laryngoscopy.
Here we report the largest experience of robotic gasless thyroid surgery in the United States. This novel technique provides excellent cosmetic results and can be performed as an outpatient procedure in selected group of patients. It is feasible and safe, however, has a lengthy learning curve.
微创选择的影响导致了甲状腺手术中新的不断发展的技术的应用，以消除可见的颈部疤痕。在这里，我们描述了一位作者在经腋窝机器人甲状腺切除术方面的经验，并研究了经验对确定学习曲线和随着时间的推移手术表现的改善的影响。
在 IRB 批准的情况下，对我们的手术经验进行了前瞻性分析。所有患者均由一位外科医生于 2009 年 9 月至 2011 年 6 月期间行经腋窝机器人甲状腺切除术。主要结局指标包括住院时间、并发症发生率以及肥胖对结局的影响。
在 91 例患者中进行了 100 例连续手术。进行了 69 例半甲状腺切除术、22 例全甲状腺切除术或近全甲状腺切除术和 9 例甲状腺切除术。行半甲状腺切除术的患者中，21.7%在 4 小时内出院；其余患者在 23 小时内出院。半甲状腺切除术的平均手术时间为 108.1 ± 60.5 分钟，全甲状腺切除术或近全甲状腺切除术的平均手术时间为 118.1 ± 51.3 分钟。所有病例的平均机器人对接时间为 9.1 ± 2.2 分钟。肥胖导致总手术时间延长。在进行 45 例手术后，手术各环节的用时明显缩短。有 2 例需要转为颈入路。术后喉镜检查未见永久性声带麻痹。
在此，我们报告了美国最大的机器人无气甲状腺手术经验。这种新的技术提供了极好的美容效果，可以在选定的患者群体中作为门诊手术进行。它是可行且安全的，但具有较长的学习曲线。
