Garstka Meghan, Mohsin Khuzema, Ali Daniah Bu, Shalaby Hosam, Ibraheem Kareem, Farag Mahmoud, Kang Sang-Wook, Kandil Emad
Tulane University School of Medicine, Department of Surgery, New Orleans, Louisiana.
Tulane University School of Medicine, Department of Surgery, New Orleans, Louisiana.
J Surg Res. 2018 Aug;228:170-178. doi: 10.1016/j.jss.2018.03.030. Epub 2018 Apr 11.
Recent studies from Asia have reported the safety and feasibility of robotic-assisted thyroid surgery. In the United States, several small series and case reports have been published, mostly regarding treatment of benign disease. The aim of our study is to report the safety and feasibility of robotic surgery for well-differentiated thyroid cancer patients at a North American institution.
We performed a retrospective cohort study using a prospectively collected single-center clinical database at Tulane University Medical Center. We included all well-differentiated thyroid cancer patients who underwent robotic-assisted or conventional cervical approach thyroid surgery with or without lymph node dissections at our institution from January 2015 to June 2017. Patient demographics and perioperative data were collected and analyzed.
A total of 144 surgeries for thyroid cancer were performed; 35 (24.3%) were robotic-assisted. There were no significant differences in estimated blood loss, operative times, complication rates, specimen sizes, positive microscopic margins, number of lymph nodes removed with associated lymph node dissections, patient follow-up duration, or clinical recurrence rates between the two groups. Overall length of stay was shorter for robotic-assisted surgery, at 0.6 ± 0.9 d, versus 1.1 ± 1.2 d for conventional open surgery (P = 0.009). For robotic-assisted surgery, 19 patients (54.3%) were discharged on the day of procedure, and only one patient was admitted as inpatient to the hospital (2.9%).
Robot-assisted thyroid surgery is a safe, feasible, and oncologically sound approach for a select group of well-differentiated thyroid cancer patients. However, long-term studies are needed.
亚洲近期的研究报告了机器人辅助甲状腺手术的安全性和可行性。在美国，已经发表了几篇小样本系列研究和病例报告，大多涉及良性疾病的治疗。我们研究的目的是报告在北美一家机构中，机器人手术治疗分化型甲状腺癌患者的安全性和可行性。
我们使用杜兰大学医学中心前瞻性收集的单中心临床数据库进行了一项回顾性队列研究。我们纳入了2015年1月至2017年6月在我们机构接受机器人辅助或传统颈部入路甲状腺手术（无论是否进行淋巴结清扫）的所有分化型甲状腺癌患者。收集并分析患者的人口统计学和围手术期数据。
共进行了144例甲状腺癌手术；35例（24.3%）为机器人辅助手术。两组在估计失血量、手术时间、并发症发生率、标本大小、显微镜下切缘阳性率、淋巴结清扫时切除的淋巴结数量、患者随访时间或临床复发率方面无显著差异。机器人辅助手术的总体住院时间较短，为0.6±0.9天，而传统开放手术为1.1±1.2天（P = 0.009）。对于机器人辅助手术，19例患者（54.3%）在手术当天出院，只有1例患者住院（2.9%）。
机器人辅助甲状腺手术对于一部分分化型甲状腺癌患者是一种安全、可行且肿瘤学上合理的方法。然而，需要进行长期研究。
