Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA.
Surgery. 2013 May;153(5):705-10. doi: 10.1016/j.surg.2012.10.013. Epub 2013 Jan 4.
There is controversy in the literature about whether robotic total thyroidectomy should be performed through unilateral or bilateral axillary incisions. The aim of this study was to perform a detailed critical analysis of the single-incision technique with a focus on postoperative pain, morbidity, and oncologic outcomes.
Between June 2009 and May 2012, 30 patients underwent robotic neck surgery through a single axillary incision. The perioperative outcomes of 16 patients who underwent robotic total thyroidectomy were compared with 30 consecutive patients undergoing conventional total thyroidectomy. Data were collected from a prospectively maintained, institutional review board-approved database. All data are presented as mean values ± standard error of the mean.
Both groups were similar regarding age, gender, body mass index, tumor size, and tumor type. For all patients, skin-to-skin operative time (OT) was less in the conventional group (139 ± 8 vs 183 ± 11 minutes, respectively; P = .002). In the robotic group, a significant improvement of the OT occurred after the 6th case: 245 ± 12 minutes for the first 6 cases versus 153 ± 10 minutes for the last 10 cases (P < .001). Estimated blood loss was similar between groups. The median hospital stay was 1 day for both groups. The morbidity was 13% in the conventional and 19% in the robotic group (P = .631).
Our results show that robotic total thyroidectomy through a single axillary incision is feasible, with similar short-term oncologic results. However, owing to the extent of dissection, the 2-week operative site discomfort is greater after robotic versus conventional total thyroidectomy.
在文献中，关于机器人甲状腺全切除术应通过单侧还是双侧腋窝切口进行存在争议。本研究旨在对单切口技术进行详细的批判性分析，重点关注术后疼痛、发病率和肿瘤学结果。
在 2009 年 6 月至 2012 年 5 月期间，有 30 名患者通过单腋窝切口接受了机器人颈部手术。将 16 名接受机器人甲状腺全切除术的患者的围手术期结果与 30 名连续接受常规甲状腺全切除术的患者进行比较。数据来自一个前瞻性维护的机构审查委员会批准的数据库。所有数据均以平均值 ± 平均值的标准误差表示。
两组在年龄、性别、体重指数、肿瘤大小和肿瘤类型方面相似。对于所有患者，常规组的皮肤对皮肤手术时间（OT）更短（分别为 139 ± 8 分钟和 183 ± 11 分钟；P =.002）。在机器人组中，第 6 例后 OT 显著改善：前 6 例为 245 ± 12 分钟，后 10 例为 153 ± 10 分钟（P <.001）。两组的估计失血量相似。中位住院时间均为 1 天。发病率在常规组为 13%，在机器人组为 19%（P =.631）。
我们的结果表明，通过单腋窝切口进行机器人甲状腺全切除术是可行的，具有相似的短期肿瘤学结果。然而，由于解剖范围的原因，与常规甲状腺全切除术相比，机器人甲状腺全切除术后 2 周的手术部位不适感更大。
