Department of Surgery, Yonsei University Health System, C.P.O. Box 8044, 250 Seongsanno, Seodaemun-gu, Seoul 120-752, South Korea.
Surg Endosc. 2013 Jul;27(7):2407-14. doi: 10.1007/s00464-012-2747-9. Epub 2013 Jan 24.
Robotic applications have achieved safe and precise thyroidectomy with notable cosmetic and functional benefits. This study was designed to document the influence of body habitus on robotic thyroidectomy in papillary thyroid carcinoma (PTC) patients.
From July 2009 to February 2010, 352 patients underwent robotic thyroidectomy using a gasless, transaxillary single-incision approach at Yonsei University Health System. Body habitus was described using body mass index category (normal weight, overweight, obese), neck length, shoulder width, and shoulder width to neck length ratios. The impact of body habitus on surgical outcomes was analyzed with respect to operation time, number of retrieved central nodes, bleeding amount, and postoperative complications.
Of the 352 patients, 217 underwent less than total thyroidectomy and 135 underwent total thyroidectomy. Operative variables (i.e. operation times, bleeding amounts, and numbers of retrieved central nodes) showed no significant differences between three BMI groups for less than total thyroidectomy. However, total operation and working space times were longer for obese patients during total thyroidectomy. In particular, shoulder width was positively correlated with total operation time, working space time, console time, and number of retrieved central nodes. On the other hand, postoperative complications were not significantly different in the three BMI groups and showed no significant correlation with the other indices of body habitus.
Standardized robotic thyroidectomy can be performed safely and feasibly in patients with a large body habitus despite longer operation times.
机器人应用已经实现了安全精确的甲状腺切除术，具有显著的美容和功能优势。本研究旨在记录体貌特征对甲状腺乳头状癌（PTC）患者机器人甲状腺切除术的影响。
2009 年 7 月至 2010 年 2 月，在延世大学健康系统，采用无气、经腋下单切口入路对 352 例患者行机器人甲状腺切除术。使用体重指数类别（正常体重、超重、肥胖）、颈长、肩宽和肩宽与颈长比来描述体貌特征。分析体貌特征对手术结果的影响，包括手术时间、中央淋巴结检出数量、出血量和术后并发症。
在 352 例患者中，217 例接受了不完全甲状腺切除术，135 例接受了全甲状腺切除术。在不完全甲状腺切除术中，三个 BMI 组之间的手术变量（即手术时间、出血量和中央淋巴结检出数量）无显著差异。然而，在全甲状腺切除术中，肥胖患者的总手术时间和工作空间时间较长。特别是，肩宽与总手术时间、工作空间时间、控制台时间和中央淋巴结检出数量呈正相关。另一方面，在三个 BMI 组中，术后并发症无显著差异，与体貌特征的其他指标也无显著相关性。
尽管手术时间较长，但标准化的机器人甲状腺切除术在体貌较大的患者中仍能安全可行地进行。
