Shan Liqun, Liu Jianing
1 Department of Surgery, The Second Hospital of Shandong University, Jinan, Shandong, China.
Surg Innov. 2019 Feb;26(1):112-123. doi: 10.1177/1553350618817145. Epub 2018 Dec 3.
Despite gaining popularity, bilateral axillo-breast approach robotic thyroidectomy (BABA RT) remains controversial. We performed a meta-analysis to evaluate the safety and effectiveness of BABA RT compared with open thyroidectomy (OT) in thyroid disease.
A literature search was conducted using various databases, including PubMed, Web of Science, and Cochrane Library, up to February 2018. Outcomes of interest included patient characteristics, surgical outcomes, adverse events, complications, and surgical completeness.
A total of 11 publications including 2733 patients (1070 in the BABA RT and 1663 in the open group) were finally selected for the meta-analysis. BABA RT was associated with an equivalent complication rate, including transient and permanent hypocalcemia, transient and permanent recurrent laryngeal nerve palsy, bleeding, chyle leakage, and seroma, as well as surgical outcomes including tumor size, length of hospital stay, total drain amount, and pain score. BABA RT was also associated with an equivalent surgical completeness, including total dose of radioactive iodine, proportion of stimulated thyroglobulin (sTg) <1.0 ng/mL, and level of sTg. Moreover, BABA RT involved longer operative times (weighted mean difference [WMD] = 110.13; P < .00001), smaller number of retrieved lymph nodes(WMD = -1.26, P = .003), and more cost (WMD = 5811.18; P < .00001) compared with OT.
BABA RT is safe and feasible and provides similar perioperative outcomes and complications when compared with OT. However, BABA RT was associated with longer operating time, fewer retrieved lymph nodes, and more cost. Randomized clinical trials with large samples and longer follow-up data are needed to more rigorously examine this effect.
尽管双侧腋窝-乳房入路机器人甲状腺切除术（BABA RT）越来越受欢迎，但仍存在争议。我们进行了一项荟萃分析，以评估BABA RT与开放性甲状腺切除术（OT）相比在甲状腺疾病治疗中的安全性和有效性。
截至2018年2月，使用包括PubMed、科学网和考克兰图书馆在内的各种数据库进行文献检索。感兴趣的结果包括患者特征、手术结果、不良事件、并发症和手术完整性。
最终共选择了11篇出版物，包括2733例患者（BABA RT组1070例，开放手术组1663例）进行荟萃分析。BABA RT的并发症发生率相当，包括短暂性和永久性低钙血症、短暂性和永久性喉返神经麻痹、出血、乳糜漏和血清肿，以及手术结果，包括肿瘤大小、住院时间、总引流量和疼痛评分。BABA RT的手术完整性也相当，包括放射性碘总剂量、刺激甲状腺球蛋白（sTg）<1.0 ng/mL的比例和sTg水平。此外，与OT相比，BABA RT的手术时间更长（加权平均差[WMD]=110.13；P<.00001），切除的淋巴结数量更少（WMD=-1.26，P=.003），费用更高（WMD=5811.18；P<.00001）。
BABA RT是安全可行的，与OT相比，围手术期结果和并发症相似。然而，BABA RT的手术时间更长，切除的淋巴结更少，费用更高。需要进行大样本和更长随访数据的随机临床试验，以更严格地检验这种效果。
