Somashekhar S P, Ashwin K R
Department of Surgical Oncology, Manipal Comprehensive Cancer Center, Bengaluru, Karnataka, India.
Manipal Comprehensive Cancer Center, Manipal Hospital, Bengaluru, Karnataka, India.
J Minim Access Surg. 2017 Oct-Dec;13(4):280-285. doi: 10.4103/jmas.JMAS_42_16.
Since last decades, more and more thyroidectomies have been performed by the minimally invasive method. Compared to conventional thyroidectomy, minimally invasive thyroidectomy has a superior cosmetic result. However, the outcome depends, in a large extent, on the skill of the operator and the learning curve is relatively long. Robotic thyroidectomy (RT) is a relatively new approach in treating thyroid lesions with improved ergonomics and surgical outcomes.
We performed a prospective study of robotic-assisted transaxillary approach for thyroidectomy in Indian patients to examine the feasibility of the procedure.
A total of 35 patients underwent RT. Demographics, surgical indications, operative findings, postoperative functional outcome, local complications and pathological outcomes were recorded and analyzed.
The median age of the cohort was 28.6 years and 31 of the patients were women. The median size of the largest nodule was 3.2 cm (range, 1.0-4.5 cm). The median size of the largest nodule was 3.2 cm (range, 1.0-4.5 cm). Eighteen patients underwent less than total thyroidectomy and 17 patients underwent total thyroidectomy, with no conversion. The mean console time standard deviation was 115 min initially, and with experience, it reduced to 106 min for subsequent cases. The mean blood loss was 13 ml. Post-operative outcome was good with no serious complication noted in our series.
Robotic-assisted thyroidectomy using a gasless transaxillary approach is a feasible, safe and noninferior surgical alternative for selected patients. We believe with time RT will be widened and it will be performed more often.
在过去几十年中，越来越多的甲状腺切除术采用了微创方法。与传统甲状腺切除术相比，微创甲状腺切除术具有更好的美容效果。然而，其结果在很大程度上取决于术者的技术，且学习曲线相对较长。机器人甲状腺切除术（RT）是一种相对较新的治疗甲状腺病变的方法，具有更好的人体工程学和手术效果。
我们对印度患者采用机器人辅助经腋窝入路甲状腺切除术进行了一项前瞻性研究，以检验该手术的可行性。
共有35例患者接受了机器人甲状腺切除术。记录并分析了患者的人口统计学数据、手术指征、术中发现、术后功能结果、局部并发症及病理结果。
该队列患者的中位年龄为28.6岁，其中31例为女性。最大结节的中位大小为3.2 cm（范围1.0 - 4.5 cm）。18例患者接受了次全甲状腺切除术，17例患者接受了全甲状腺切除术，无一例中转。最初平均控制台操作时间标准差为115分钟，随着经验积累，后续病例的平均控制台操作时间降至106分钟。平均失血量为13 ml。术后结果良好，本系列中未发现严重并发症。
对于选定的患者，采用无气经腋窝入路的机器人辅助甲状腺切除术是一种可行、安全且不逊色的手术选择。我们相信随着时间的推移，机器人甲状腺切除术的应用范围将会扩大，实施频率也会更高。
