Giulianotti Pier Cristoforo, Addeo Pietro, Buchs Nicolas Christian, Ayloo Subhashini M, Bianco Francesco Maria
Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois 60612, USA.
J Laparoendosc Adv Surg Tech A. 2012 May;22(4):387-91. doi: 10.1089/lap.2010.0380. Epub 2012 Apr 10.
Thyroid surgery has recently emerged as one of the most promising fields for the application of robotic surgery. We report the results of the first year of experience with a gasless transaxillary thyroidectomy.
From January 2009 to December 2009, 10 consecutive patients (8 women) underwent robotic thyroidectomy through a gasless transaxillary approach. The median age was 44 years (range, 27-42 years). Eight total and two partial thyroidectomies (one left and one right) were performed using the da Vinci(®) Robotic Surgical System (Intuitive Surgical, Sunnyvale, CA). Preoperative diagnosis included solitary nodules with a median size of 16±11 mm (range, 3-44 mm) at preoperative imaging.
All procedures were successfully completed robotically, except one that was converted because of difficulty in achieving an optimal exposure. The overall mean operative time was 177.4±40 minutes (range, 120-240 minutes) with minimal blood loss (<10 mL). Pathological diagnoses included papillary carcinoma (n=6), colloid nodule (n=2), and multinodular goiter (n=2). The mean number of lymph nodes harvested in the cases of malignant disease was 4±5 (range, 3-15). The median postoperative length of stay was 1.05 days (range, 1-1.4 days).
Thyroid surgery using a gasless transaxillary approach can be performed safely for selected benign and malignant pathology. This approach offers superior cosmetic results and a short hospital stay over conventional thyroid surgery. For selected patients, this technique offers a promising scarless option for minimally invasive thyroid surgery.
甲状腺手术最近已成为机器人手术应用最有前景的领域之一。我们报告了无气经腋窝甲状腺切除术第一年的经验结果。
2009年1月至2009年12月，连续10例患者（8例女性）通过无气经腋窝入路接受机器人甲状腺切除术。中位年龄为44岁（范围27 - 42岁）。使用达芬奇®机器人手术系统（直观外科公司，加利福尼亚州桑尼维尔）进行了8例全甲状腺切除术和2例部分甲状腺切除术（1例左侧和1例右侧）。术前诊断包括术前影像学检查中大小中位数为16±11毫米（范围3 - 44毫米）的孤立结节。
除1例因难以实现最佳暴露而中转外，所有手术均成功通过机器人完成。总体平均手术时间为177.4±40分钟（范围120 - 240分钟），失血极少（<10毫升）。病理诊断包括乳头状癌（n = 6）、胶样结节（n = 2）和多结节性甲状腺肿（n = 2）。恶性疾病病例中平均切除的淋巴结数量为4±5个（范围3 - 15个）。术后中位住院时间为1.05天（范围1 - 1.4天）。
对于选定的良性和恶性病变，采用无气经腋窝入路的甲状腺手术可以安全进行。与传统甲状腺手术相比，这种入路具有更好的美容效果和较短的住院时间。对于选定的患者，该技术为微创甲状腺手术提供了一种有前景的无瘢痕选择。
