Son Haiyoung, Park Seulkee, Lee Cho Rok, Lee Sohee, Kim Jung Woo, Kang Sang-Wook, Jeong Jong Ju, Nam Kee-Hyun, Chung Woong Youn, Park Cheong Soo
Department of Surgery, International St. Mary's Hospital, Incheon Metropolitan City, Republic of Korea,
Surg Endosc. 2014 Nov;28(11):3134-42. doi: 10.1007/s00464-014-3567-x. Epub 2014 May 31.
Transaxillary robotic thyroidectomy is considered a technically feasible and safe treatment option for patients with low-risk papillary thyroid carcinoma (PTC). The aim of the present study was to determine the factors that contribute to the perioperative surgical outcomes of robotic thyroidectomy and to suggest guidelines for patient selection to be used by surgeons inexperienced in the technique.
We reviewed the records of 275 patients with PTC who underwent robotic total thyroidectomy using a gasless, transaxillary single-incision approach at Yonsei University Health System, South Korea, between January 2011 and May 2012. The association between surgical outcomes and clinicopathologic factors was assessed using linear and logistic regression analysis.
The contributing factors for surgical outcomes of robotic thyroidectomy were categorized as patient factors, including gender and body mass index (BMI), and thyroid-specific factors, including thyroid gland size, coexistent thyroiditis, tumor size, and serum anti-thyroglobulin antibody and anti-microsomal antibody titers. Of these, male gender, a large thyroid gland, and thyroiditis significantly increased the total operation time. Male gender, thyroiditis, and overweight BMI increased the working space time, and a large thyroid gland and overweight BMI affected the console time. A large thyroid gland and histological thyroiditis were associated with increased intraoperative blood loss. There was no association between postoperative complications and clinicopathologic parameters.
Male gender, overweight BMI, a large thyroid gland, and coexistent thyroiditis adversely affected the surgical outcome of robotic thyroidectomy. Surgeons inexperienced in the technique should avoid or carefully approach individuals with these factors.
经腋窝机器人甲状腺切除术被认为是低风险甲状腺乳头状癌（PTC）患者的一种技术上可行且安全的治疗选择。本研究的目的是确定影响机器人甲状腺切除术围手术期手术结果的因素，并为该技术经验不足的外科医生提供患者选择指南。
我们回顾了2011年1月至2012年5月在韩国延世大学健康系统采用无气、经腋窝单切口入路接受机器人全甲状腺切除术的275例PTC患者的记录。使用线性和逻辑回归分析评估手术结果与临床病理因素之间的关联。
机器人甲状腺切除术手术结果的影响因素分为患者因素，包括性别和体重指数（BMI），以及甲状腺特异性因素，包括甲状腺大小、并存的甲状腺炎、肿瘤大小以及血清抗甲状腺球蛋白抗体和抗微粒体抗体滴度。其中，男性、甲状腺肿大和甲状腺炎显著增加了总手术时间。男性、甲状腺炎和超重BMI增加了操作空间时间，甲状腺肿大和超重BMI影响了控制台时间。甲状腺肿大和组织学甲状腺炎与术中出血量增加有关。术后并发症与临床病理参数之间无关联。
男性、超重BMI、甲状腺肿大和并存的甲状腺炎对机器人甲状腺切除术的手术结果有不利影响。该技术经验不足的外科医生应避免或谨慎对待有这些因素的患者。
