Kwak JungHak, Kim Su-Jin, Xu Zhen, Lee Keunchul, Ahn Jong-Hyuk, Yu Hyeong Won, Chai Young Jun, Choi June Young, Lee Kyu Eun
Department of Surgery, Seoul National University College of Medicine, Seoul 03080, Korea.
Thyroid Center, Division of Surgery, Seoul National University Cancer Hospital, Seoul 03080, Korea.
J Clin Med. 2021 Apr 15;10(8):1707. doi: 10.3390/jcm10081707.
Bilateral axillo-breast approach (BABA) robotic thyroidectomy has been successfully performed for thyroid cancer patients with excellent cosmetic results. Completion thyroidectomy is sometimes necessary after thyroid lobectomy, and whether it has a higher complication rate than the primary operation due to the presence of adhesions remains controversial. The aim of this study was to evaluate surgical outcomes, including operation time and postoperative complications, in patients who underwent BABA robotic completion thyroidectomy.
From Jan 2012 to Aug 2020, 33 consecutive patients underwent BABA robotic completion thyroidectomy for a thyroid malignancy after BABA robotic thyroid lobectomy. The procedures were divided into five steps: (1) robot setting and surgical draping, (2) flap dissection, (3) robot docking, (4) thyroidectomy, and (5) closure. Clinicopathological characteristics, operation time, and postoperative complications were reviewed.
The total operation time was shorter for completion thyroidectomy than for the initial operation (164.8 ± 31.7 min vs. 179.8 ± 27.1 min, = 0.043). Among the robotic thyroidectomy steps, the duration of the thyroidectomy step was shorter than that of the initial operation (69.6 ± 20.9 min vs. 83.0 ± 19.5 min, = 0.009. One patient (1/33, 3.0%) needed hematoma evacuation under the flap area immediately after surgery. Three patients (3/33, 9.1%) showed transient hypoparathyroidism, and one patient (1/33, 3.0%) had permanent hypoparathyroidism. Two patients (2/33, 6.1%) showed transient vocal cord palsy and recovered within 3 months following the completion thyroidectomy. There were no cases of open conversion, tracheal injury, flap injury or wound infection.
BABA robotic completion thyroidectomy could be performed safely without completion-related complication.
双侧腋窝-乳房入路（BABA）机器人甲状腺切除术已成功应用于甲状腺癌患者，美容效果极佳。甲状腺叶切除术后有时需要行甲状腺全切术，由于存在粘连，其并发症发生率是否高于初次手术仍存在争议。本研究旨在评估接受BABA机器人甲状腺全切术患者的手术效果，包括手术时间和术后并发症。
2012年1月至2020年8月，33例连续患者在接受BABA机器人甲状腺叶切除术后，因甲状腺恶性肿瘤接受BABA机器人甲状腺全切术。手术过程分为五个步骤：（1）机器人设置和手术铺巾，（2）皮瓣分离，（3）机器人对接，（4）甲状腺切除术，（5）缝合。回顾临床病理特征、手术时间和术后并发症。
甲状腺全切术的总手术时间比初次手术短（164.8±31.7分钟对179.8±27.1分钟，P=0.043）。在机器人甲状腺切除步骤中，甲状腺切除步骤的持续时间比初次手术短（69.6±20.9分钟对83.0±19.5分钟，P=0.009）。1例患者（1/33，3.0%）术后立即需要在皮瓣区域进行血肿清除。3例患者（3/33，9.1%）出现短暂性甲状旁腺功能减退，1例患者（1/33，3.0%）出现永久性甲状旁腺功能减退。2例患者（2/33，6.1%）出现短暂性声带麻痹，并在甲状腺全切术后3个月内恢复。无开放转换、气管损伤、皮瓣损伤或伤口感染病例。
BABA机器人甲状腺全切术可安全进行，无与手术相关的并发症。
