Yang Sun Moon, Park Won Seo, You Ji Young, Park Da Won, Kangleon-Tan Hannah Lois, Kim Hong Kyu, Dionigi Gianlorenzo, Kim Hoon Yub, Tufano Ralph P
Department of Surgery, KUMC Thyroid Center, Korea University Hospital, Korea University College of Medicine, Seoul, Korea.
Department of Surgery, Kyung Hee University School of Medicine, Seoul, Korea.
Gland Surg. 2020 Dec;9(6):1998-2004. doi: 10.21037/gs-20-468.
The use of robotic systems for thyroidectomy has increased as it enables more diverse approaches than the conventional open method. The aim of this study was to compare the clinical outcomes of Transoral Robotic Thyroidectomy (TORT) and Bilateral Axillo-Breast Approach-Robotic Thyroidectomy (BABA-RT).
This study was designed as a retrospective study. The included patients who underwent surgery by BABA-RT or TORT approach in our facility between 2008 and 2018. All surgeries were performed by one surgeon. Total thyroidectomy with central node dissection (CND) was performed only if tumors were >4 cm and had extrathyroidal extension, clinically apparent lymph node or distant metastases. In all other cases, lobectomy ± CND was performed.
The group treated with TORT comprised 248 patients and the group that underwent BABA-RT had 316 patients. The number of retrieved lymph node (LN) was higher in the TORT group (4.9±4.4 4.2±4.9; P=0.01). There were no significant differences between the TORT and BABA-RT groups in concerns to the location of the tumor. Postoperative hospital stay was also shorter in the TORT group when compared with the BABA-RT group (2.8±0.90 3.4±0.97 days, P=0.012). Operative time was significantly shorter in the TORT group (204.11±40.19 243.78±57.16 min, P<0.01).
When comparing a total of 248 patients treated with TORT versus 316 with BABA-RT. TORT not only has advantages in better cosmetic outcomes with minimized postoperative scars, but also shows comparable, or even superior, surgical outcomes with shorter operation time than the BABA-RT procedure.
随着机器人系统在甲状腺切除术中的应用，其能实现比传统开放手术更多样化的入路方式，应用逐渐增多。本研究旨在比较经口机器人甲状腺切除术（TORT）和双侧腋窝-乳晕入路机器人甲状腺切除术（BABA-RT）的临床疗效。
本研究为回顾性研究。纳入2008年至2018年期间在我院采用BABA-RT或TORT入路进行手术的患者。所有手术均由同一外科医生完成。仅当肿瘤直径>4 cm且有甲状腺外侵犯、临床可见淋巴结或远处转移时，才进行全甲状腺切除加中央区淋巴结清扫（CND）。在所有其他情况下，进行甲状腺叶切除±CND。
接受TORT治疗的组有248例患者，接受BABA-RT治疗的组有316例患者。TORT组的淋巴结（LN）清扫数量更高（4.9±4.4对4.2±4.9；P=0.01）。TORT组和BABA-RT组在肿瘤位置方面无显著差异。与BABA-RT组相比，TORT组的术后住院时间也更短（2.8±0.90对3.4±0.97天，P=0.012）。TORT组的手术时间明显更短（204.11±40.19对243.78±57.16分钟，P<0.01）。
比较总共248例接受TORT治疗的患者和316例接受BABA-RT治疗的患者，TORT不仅在术后瘢痕最小化方面具有更好的美容效果优势，而且与BABA-RT手术相比，还具有相当甚至更优的手术效果，手术时间更短。
