Department of Otolaryngology-Head & Neck Surgery, Wayne State University and Karmanos Cancer Institute, Detroit, MI 48201, USA.
Otolaryngol Head Neck Surg. 2012 Dec;147(6):1041-6. doi: 10.1177/0194599812461610. Epub 2012 Sep 24.
We reviewed our initial experience with robotic thy-roidectomy to identify challenges and limitations of this new surgical approach when applied to a North American population.
Case series.
Academic institution.
SUBJECTS/METHODS: Retrospective review of 18 consecutive robotic thyroid lobectomies performed from February 2010 to April 2012 involving 16 female patients. Two patients underwent robot-assisted completion thyroidectomy a few months following the initial thyroid surgery, one for cancer and the other for goiter.
Median age was 47.5 years (range, 18-62 years), and median body mass index was 28.7 (range, 19.4-44.5). Median thyroid nodule size was 2.9 cm (range, 1.1-4.7 cm). All but 1 case (6%) was performed successfully via single axillary incision. There was no conversion to an open approach. Median operative time was 170 minutes (range, 95-220 minutes), and median blood loss was 12.5 mL (range, 5-75 mL). Complications occurred in 4 cases (22%) to include temporary vocal cord pareses (n = 3) and a postoperative hematoma that required exploration. Median hospital stay was 2 days (range, 1-3 days).
Single-incision transaxillary robotic thyroidectomy can be technically challenging in North American patients with a larger body frame due to difficulty in optimal placement of all 4 robotic instruments via a single axillary incision. All 3 cases of temporary vocal cord paresis occurred early in our experience and may have been due to our relative inexperience with this new approach and associated instrumentation. Other limitations include less than optimal visualization of the recurrent laryngeal nerve in the contralateral lobe as well as poor access to the substernal region.
我们回顾了机器人甲状腺切除术的初步经验，以确定将这种新的手术方法应用于北美人群时所面临的挑战和局限性。
病例系列研究。
学术机构。
研究对象/方法：回顾性分析 2010 年 2 月至 2012 年 4 月期间连续 18 例机器人甲状腺叶切除术的病例，涉及 16 名女性患者。其中 2 例患者在初次甲状腺手术后几个月接受了机器人辅助完成甲状腺切除术，1 例为癌症，另 1 例为甲状腺肿。
中位年龄为 47.5 岁（范围 18-62 岁），中位体重指数为 28.7（范围 19.4-44.5）。甲状腺结节中位大小为 2.9cm（范围 1.1-4.7cm）。除 1 例（6%）外，其余病例均通过单一腋窝切口成功完成。无中转开放手术。中位手术时间为 170 分钟（范围 95-220 分钟），中位出血量为 12.5ml（范围 5-75ml）。4 例（22%）发生并发症，包括暂时性声带麻痹（n=3）和术后血肿需要探查。中位住院时间为 2 天（范围 1-3 天）。
由于在单个腋窝切口内难以最佳放置所有 4 个机器人器械，因此对于身材较大的北美患者，单切口经腋窝入路机器人甲状腺切除术在技术上具有挑战性。我们经验中的 3 例暂时性声带麻痹均发生较早，可能是由于我们对这种新方法和相关器械的相对不熟悉所致。其他局限性包括对侧叶中喉返神经的可视性较差以及对胸骨后区域的进入困难。
4。
