Kim Hong Kyu, Chai Young Jun, Dionigi Gianlorenzo, Berber Eren, Tufano Ralph P, Kim Hoon Yub
Department of Surgery, KUMC Thyroid Center, Korea University Hospital, Korea University College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea.
Department of Surgery, Seoul National University Boramae Medical Center, Seoul, Republic of Korea.
World J Surg. 2019 Apr;43(4):1038-1046. doi: 10.1007/s00268-018-04877-w.
Endoscopic transoral thyroidectomy is a recently introduced technique of remote access thyroidectomy. We previously reported the feasibility of the robotic approach (TORT). Nevertheless, experience to date is limited, with scant data on outcomes in patients with papillary thyroid carcinoma (PTC).
This was a retrospective analysis of prospectively collected data. Patients with PTC, who underwent TORT at a single center between March 2016 and February 2017, were analyzed.
There were a total of 100 patients (85 women, 15 men) with a mean age of 40.7 ± 9.8 years, and a mean tumor size of 0.8 ± 0.5 cm. Nine patients underwent a total thyroidectomy, and 91 underwent a lobectomy. The operative time for a total thyroidectomy and lobectomy was 270.0 ± 9.3 and 210.8 ± 32.9 min, respectively. Ipsilateral prophylactic central neck compartment dissection was performed routinely with retrieval of 5.0 ± 3.6 lymph nodes. Perioperative morbidity was present in nine patients including transient recurrent laryngeal nerve palsy (n = 1), postoperative bleeding requiring surgical intervention (n = 1), zygomatic bruising (n = 2), chin flap perforation (n = 1), oral commissure tearing (n = 2), and chin dimpling (n = 2). There was no conversion to endoscopic or conventional open thyroid surgery.
In this study, TORT could be safely performed in a large series of patients with PTC without serious complications. In selected patients, TORT by experienced surgeons could be considered an alternative approach for remote access thyroidectomy.
内镜经口甲状腺切除术是一种最近引入的远程入路甲状腺切除技术。我们之前报道了机器人辅助手术方法（TORT）的可行性。然而，迄今为止经验有限，关于甲状腺乳头状癌（PTC）患者的手术结果数据很少。
这是一项对前瞻性收集数据的回顾性分析。分析了2016年3月至2017年2月期间在单一中心接受TORT的PTC患者。
共有100例患者（85例女性，15例男性），平均年龄40.7±9.8岁，平均肿瘤大小0.8±0.5cm。9例患者接受了全甲状腺切除术，91例接受了甲状腺叶切除术。全甲状腺切除术和甲状腺叶切除术的手术时间分别为270.0±9.3分钟和210.8±32.9分钟。常规进行同侧预防性中央颈淋巴结清扫，平均取出5.0±3.6枚淋巴结。9例患者出现围手术期并发症，包括短暂性喉返神经麻痹（n = 1）、术后出血需手术干预（n = 1）、颧骨瘀伤（n = 2）、颏下皮瓣穿孔（n = 1）、口角撕裂（n = 2）和颏下凹陷（n = 2）。没有转为内镜或传统开放甲状腺手术的情况。
在本研究中，TORT可以在大量PTC患者中安全进行，且无严重并发症。对于选定的患者，经验丰富的外科医生进行的TORT可被视为远程入路甲状腺切除术的一种替代方法。
