Department of Surgery, Eulji University College of Medicine, 139-872 Seoul, Korea.
J Clin Endocrinol Metab. 2013 Jul;98(7):2701-8. doi: 10.1210/jc.2013-1583. Epub 2013 May 15.
Robotic total thyroidectomy (TT) with modified radical neck dissection (MRND) using a gasless transaxillary approach has been reported safe and effective in patients with N1b papillary thyroid carcinoma (PTC), with notable cosmetic benefits when compared with conventional open TT. We have compared oncological outcomes and quality of life (QoL) in PTC patients undergoing robotic TT and MRND and those undergoing conventional open procedures.
Between March 2010 and July 2011, 128 patients with PTC and lateral neck node metastases underwent TT with MRND, including 62 who underwent robotic and 66 who underwent open TT. We compared oncologic outcomes and safety as well as functional outcomes such as postoperative subjective voice and swallowing difficulties. We also evaluated neck pain, sensory changes, and cosmetic satisfaction after surgery using various QoL symptom scales. Neck and shoulder disability was assessed using arm abduction tests (AAT) and questions from the neck dissection impairment index (NDII).
Although the mean operating time was significantly longer in the robotic (mean, 271.8 ± 50.2 min) than in the open group (mean, 208.9 ± 56.3 min) (P < .0001), postoperative complication rates and oncologic outcomes, including the results of radioactive iodine scans and postoperative serum Tg concentrations, did not differ significantly. Subjective voice outcomes and postoperative AAT and neck dissection impairment index were also similar, but postoperative swallowing difficulties (P = .0041) and sensory changes (P < .0001) were significantly more frequent in the open than in the robotic group. In particular, mean cosmetic satisfaction score was significantly higher in the robotic than in the open group (P < .0001).
Robotic TT with MRND yielded similar oncologic outcomes and safety as conventional open procedures, with similar recovery of neck and shoulder disability. However, the robot technique resulted in better QoL outcomes, including better cosmetic results and reductions in neck sensory changes and swallowing discomfort.
经腋入路无气腔甲状腺全切除术（TT）联合改良根治性颈淋巴结清扫术（MRND）已被报道在 N1b 期甲状腺乳头状癌（PTC）患者中安全且有效，与传统开放 TT 相比，具有显著的美容优势。我们比较了接受机器人 TT 和 MRND 与接受传统开放手术的 PTC 患者的肿瘤学结果和生活质量（QoL）。
2010 年 3 月至 2011 年 7 月，128 例 PTC 伴侧颈部淋巴结转移患者接受 TT 联合 MRND，其中 62 例接受机器人手术，66 例接受开放 TT。我们比较了肿瘤学结果和安全性以及术后主观嗓音和吞咽困难等功能结果。我们还使用各种 QoL 症状量表评估了术后颈痛、感觉变化和美容满意度。采用臂外展试验（AAT）和颈清扫术损伤指数（NDII）的问题评估颈肩功能障碍。
虽然机器人组的平均手术时间明显长于开放组（分别为 271.8 ± 50.2 分钟和 208.9 ± 56.3 分钟）（P <.0001），但术后并发症发生率和肿瘤学结果，包括放射性碘扫描和术后血清 Tg 浓度结果，无显著差异。主观嗓音结果和术后 AAT 和颈清扫术损伤指数也相似，但开放组术后吞咽困难（P =.0041）和感觉变化（P <.0001）明显多于机器人组。特别是，机器人组的平均美容满意度评分明显高于开放组（P <.0001）。
经腋入路无气腔甲状腺全切除术联合改良根治性颈淋巴结清扫术与传统开放手术相比，具有相似的肿瘤学结果和安全性，且颈肩功能障碍的恢复情况相似。然而，机器人技术可获得更好的 QoL 结果，包括更好的美容效果，以及减少颈部感觉变化和吞咽不适。
