Chen Yu-Hsien, Kim Hoon-Yub, Anuwong Angkoon, Huang Ting-Shuo, Duh Quan-Yang
Department of General Surgery, Keelung Chang Gung Memorial Hospital, Keelung, No. 222, Maijin Rd., Anle Dist., Keelung City, 20401, Taiwan.
Department of Surgery, KUMC Thyroid center, Korea University Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
Surg Endosc. 2021 Nov;35(11):6179-6189. doi: 10.1007/s00464-020-08114-1. Epub 2020 Oct 27.
Transoral endoscopic thyroidectomy vestibular approach (TOETVA) has been shown to be safe and has similar outcomes as open thyroidectomy for selected patients. It is not clear if transoral robotic thyroidectomy (TORT) may extend transoral endoscopic thyroidectomy to more complex thyroid operations. The study aimed to compare the safety and outcomes of TORT with those of TOETVA.
We retrospectively reviewed all patients who had TORT and TOETVA performed by a single surgeon from June 2017 to May 2019. Intrathoracic goiter and combined operations were excluded. Surgical outcomes were compared after propensity score matching. Learning curves, as measured by operating time, were evaluated.
A total of 150 patients underwent 154 transoral (55 TORT and 99 TOETVA) thyroidectomy. Of the 154 operations, 28 (18.2%) were bilateral total thyroidectomy and 126 (81.8%) were unilateral thyroid lobectomy. After propensity score matching, we found a longer operative time (median [interquartile range]) for TORT (n = 53) than for the TOETVA (308 [284-388] vs 228 [201-267] min, P < 0.001). Blood loss and visual analog scale scores for pain were not significantly different between the two groups. Central neck lymph node dissection was performed more frequent in the TORT group (28 of 53 [52.8%] vs 10 of 53 [18.9%], P = 0.001), and when performed, the numbers of total and positive lymph nodes did not differ significantly between the two groups. The rates of hypoparathyroidism and recurrent laryngeal nerve injury did not differ significantly between the two groups. There was no conversion to open thyroidectomy, mental nerve injury, or surgical site infection. The learning curve for TORT was 25 cases, but no obvious learning curve was observed for TOETVA.
TORT requires a longer operative time, but is as safe as TOETVA and may be useful for more complex thyroid operations.
经口内镜甲状腺手术前庭入路（TOETVA）已被证明是安全的，对于特定患者，其手术效果与开放性甲状腺手术相似。经口机器人甲状腺手术（TORT）是否能将经口内镜甲状腺手术扩展到更复杂的甲状腺手术尚不清楚。本研究旨在比较TORT与TOETVA的安全性和手术效果。
我们回顾性分析了2017年6月至2019年5月由同一外科医生进行TORT和TOETVA的所有患者。排除胸内甲状腺肿和联合手术患者。在倾向得分匹配后比较手术效果。通过手术时间评估学习曲线。
共有150例患者接受了154例经口甲状腺手术（55例TORT和99例TOETVA）。在这154例手术中，28例（18.2%）为双侧全甲状腺切除术，126例（81.8%）为单侧甲状腺叶切除术。倾向得分匹配后，我们发现TORT组（n = 53）的手术时间（中位数[四分位间距]）比TOETVA组长（308[284 - 388]分钟对228[201 - 267]分钟，P < 0.001）。两组的失血量和视觉模拟疼痛评分无显著差异。TORT组中央区颈部淋巴结清扫的频率更高（53例中的28例[52.8%]对53例中的10例[18.9%]，P = 0.001），且清扫时两组的总淋巴结数和阳性淋巴结数无显著差异。两组甲状旁腺功能减退和喉返神经损伤的发生率无显著差异。无转为开放性甲状腺手术、颏神经损伤或手术部位感染的情况。TORT的学习曲线为25例，但未观察到TOETVA有明显的学习曲线。
TORT手术时间较长，但与TOETVA一样安全，可能对更复杂的甲状腺手术有用。
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