Haidar Ismail Nathalie, Tavalla Pardis, Uppal Pulkita, Adel Awad Mohammed Shaza, Rajashekar Shriya, Giri Ravindran Suganya, Kakarla Meghana, Ausaja Gambo Musa, Yousri Salama Mustafa, Hamid Pousette
Research, California Institute of Behavioral Neurosciences & Psychology, California, USA.
Neurology, California Institute of Behavioral Neurosciences & Psychology, California, USA.
Cureus. 2022 Jun 25;14(6):e26320. doi: 10.7759/cureus.26320. eCollection 2022 Jun.
Over a hundred thousand thyroid surgeries are performed per year in the United States. Although conventional thyroidectomy has successful surgical outcomes, robotic minimally invasive procedures, known for their scar free (regarding the neck, no collar incision) surgical outcomes gained popularity through the years. Furthermore, these techniques are new and still debatable. The purpose is to know the advantages of robotic over open thyroidectomy in thyroid diseases. Note that we didn't aim to compare different robotic techniques due to the lack of data. We performed a systematic review comparing surgical approaches for thyroidectomy, open vs robotic techniques, from January 2017 to December 2021, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. All papers with no full free article access and not in the English language were excluded. The outcomes of interest were superior cosmetics outcome, cost-effectiveness, limitations, operation time, length of hospital stay and postoperative pain or complications, and future outcomes. A literature search was carried out in electronic databases (PubMed, Google Scholar) in order to retrieve all papers comparing the effectiveness of robotic vs open thyroidectomy. An initial reference search yielded 433 articles. Finally, we chose nine studies covering different robotic thyroidectomy techniques compared to the open thyroidectomy approach. Promising results were seen in these studies, especially with superior cosmetic results, less post-operative pain, swallowing discomfort, and voice changes. In addition, the risk of recurrent laryngeal nerve injury is almost the same as the open approach. Multiple types of biases were caused by the selection of the population and the limitation of the studies to certain regions associated with the low numbers of robotic thyroidectomy approaches in Europe and the United States of America and the lack of randomized trials and long-term follow-up respectively. All studies discussed the importance of the surgeon's skills and the patient decision in choosing the appropriate approach for the thyroidectomy depending on the risk factors, a larger number of patients, and longer follow-up from multiple hospitals.
在美国，每年进行超过十万例甲状腺手术。尽管传统甲状腺切除术手术结果成功，但近年来，以无瘢痕（颈部无领口切口）手术结果著称的机器人微创甲状腺手术越来越受欢迎。此外，这些技术尚新且仍存在争议。目的是了解机器人甲状腺切除术相对于开放性甲状腺切除术治疗甲状腺疾病的优势。需要注意的是，由于缺乏数据，我们未旨在比较不同的机器人技术。我们根据系统评价和Meta分析的首选报告项目（PRISMA）2020指南，对2017年1月至2021年12月期间甲状腺切除术的手术方式（开放性与机器人技术）进行了系统评价。所有无法免费获取全文且非英文的论文均被排除。感兴趣的结果包括更好的美容效果、成本效益、局限性、手术时间、住院时间以及术后疼痛或并发症，还有未来的结果。为检索所有比较机器人甲状腺切除术与开放性甲状腺切除术有效性的论文，我们在电子数据库（PubMed、谷歌学术）中进行了文献检索。初步参考文献检索得到433篇文章。最后，我们选择了9项研究，这些研究涵盖了与开放性甲状腺切除术方法相比的不同机器人甲状腺切除术技术。在这些研究中看到了有前景的结果，尤其是美容效果更好、术后疼痛更少、吞咽不适和声音改变更少。此外，喉返神经损伤的风险与开放性手术方法几乎相同。由于研究人群的选择以及研究限于某些地区等多种偏倚，分别与欧洲和美国机器人甲状腺切除术方法数量较少以及缺乏随机试验和长期随访有关。所有研究都讨论了外科医生技能以及患者在根据风险因素、更多患者数量和多家医院的更长随访情况选择合适的甲状腺切除术方法时的决策的重要性。
