Piccoli Micaela, Mullineris Barbara, Gozzo Davide, Colli Giovanni, Pecchini Francesca, Nigro Casimiro, Rochira Vincenzo
1 Department of General and Emergency Surgery, Azienda Ospedaliero-Universitaria Modena, Modena, Italy.
2 General Surgery Department, Torvergata University, Rome, Italy.
J Laparoendosc Adv Surg Tech A. 2019 Apr;29(4):433-440. doi: 10.1089/lap.2019.0021. Epub 2019 Mar 21.
In the past 20 years, the fast spread of new surgical technologies has reached an important peak with the advent of the robotic surgery. Many studies have been run about a cosmetic desire to avoid neck scars after thyroid surgery and this has led to the development of remote access robotic thyroidectomy (RT). Among the various RT approaches, unilateral transaxillary access is one of the most widely used, reporting excellent results in terms of feasibility and patient's compliance. The mini-invasive technique demonstrated many potential shortcoming overcomes with the robotic approach. At our institution a team of 3 skilled endocrine surgeons with experience in laparoscopic and robotic procedures performed RT. Our aim is to report our 8-year single-centre robot-assisted thyroidectomy experience, by applying a gasless unilateral transaxillary approach with the so-called hybrid technique, and to demonstrate its safety and feasibility.
In the period between September 2010 and June 2018 at our institution, a total of 472 patients underwent thyroid and parathyroid transaxillary surgery. The hybrid technique was applied for all the robotic procedures. A total of 412 procedures were performed with the use of external "Modena Retractor" (CEATEC Medizintechnik) and with 3 surgeons. According to international guidelines, our indications for robotic surgery were benign lesions with a diameter <5 cm, Graves' disease, well-differentiated thyroid cancers, and parathyroid adenomas.
In this series, a total of 449 cases were registered. General data of patients were analyzed: gender, age, body mass index, tumor size, preoperative fine-needle aspiration examination, definitive histological examination, operative time, and postoperative complications.
This study confirms the application of robotic approach in thyroid surgery as a feasible technique in terms of safety and complications risk. The hybrid technique, together with a dedicated surgical team, can lead to obtaining the same outcomes of traditional anterior cervicotomic surgery, adding a scarless thyroidectomy.
在过去20年里，随着机器人手术的出现，新的外科技术迅速传播，达到了一个重要的高峰。关于甲状腺手术后避免颈部瘢痕的美容需求已经开展了许多研究，这促使了远程接入机器人甲状腺切除术（RT）的发展。在各种RT方法中，单侧经腋窝入路是应用最广泛的方法之一，在可行性和患者依从性方面报告了出色的结果。微创技术显示出的许多潜在缺点通过机器人方法得以克服。在我们机构，一组3名熟练的内分泌外科医生，他们在腹腔镜和机器人手术方面有经验，进行了RT手术。我们的目的是报告我们8年的单中心机器人辅助甲状腺切除术经验，采用无气单侧经腋窝入路和所谓的混合技术，并证明其安全性和可行性。
在2010年9月至2018年6月期间，我们机构共有472例患者接受了甲状腺和甲状旁腺经腋窝手术。所有机器人手术均采用混合技术。总共412例手术使用了外部“摩德纳牵开器”（CEATEC医疗技术公司），由3名外科医生进行操作。根据国际指南，我们进行机器人手术的指征是直径<5 cm的良性病变、格雷夫斯病、高分化甲状腺癌和甲状旁腺腺瘤。
在本系列中，共记录了449例病例。分析了患者的一般数据：性别、年龄、体重指数、肿瘤大小、术前细针穿刺检查、最终组织学检查、手术时间和术后并发症。
本研究证实了机器人方法在甲状腺手术中的应用在安全性和并发症风险方面是一种可行的技术。混合技术与专业的手术团队一起，可以获得与传统颈前切开手术相同的结果，同时增加无瘢痕甲状腺切除术。
