Department of Breast and Thyroid Surgery, Southwest Hospital, the First Affiliated Hospital of the Army Military Medical University, Gaotanyan Street 29, Shapingba District, Chongqing, 400038, China.
Int J Surg. 2023 Dec 1;109(12):3974-3982. doi: 10.1097/JS9.0000000000000725.
To compare robot-assisted thyroidectomy (RT) and open thyroidectomy (OT) through a prospective cohort study focusing on the rate of postoperative hypoparathyroidism, efficacy, and quality of life (QoL).
Hypoparathyroidism is a frequent complication after thyroidectomy. Reducing the risk of hypoparathyroidism after total thyroidectomy is a crucial and difficult task for thyroid surgeons.
We prospectively enroled 306 patients with papillary thyroid carcinoma into an RT group and OT group. The former used "super-meticulous" capsular dissection) and the latter used traditional meticulous capsular dissection. Patients were evaluated by scales [Short Form (SF)-36, Visual Impairment Scale (VIS), Swallowing Impairment Scale (SIS), Neck Impairment Scale (NIS), Scar questionnaire (SCAR-Q)].
The rates of transient hypoparathyroidism, permanent hypoparathyroidism, and transient hypocalcemia after surgery in the OT group and RT group were significantly different ( P <0.001). SIS and VIS scores in the two groups were significantly different ( P <0.001). SF-36 showed significant differences ( P <0.001) in the subsections of "physiological function", "body pain", "general health", "vitality", "social function", "role emotional", and "mental health" between the two groups. SCAR-Q showed that the length and appearance of scars showed significant differences between the two groups.
RT with Super-meticulous capsular dissection can protect parathyroid function and improve postoperative QoL, and could be a new option for robot-assisted surgery against thyroid cancer.
通过前瞻性队列研究比较机器人辅助甲状腺切除术（RT）和开放甲状腺切除术（OT），重点关注术后甲状旁腺功能减退症的发生率、疗效和生活质量（QoL）。
甲状旁腺功能减退症是甲状腺手术后的常见并发症。降低全甲状腺切除术后甲状旁腺功能减退症的风险是甲状腺外科医生的一项关键且艰巨的任务。
我们前瞻性地将 306 例甲状腺乳头状癌患者纳入 RT 组和 OT 组。前者采用“超精细”包膜剥离术，后者采用传统精细包膜剥离术。采用量表[SF-36（Short Form 36）、视觉障碍量表（VIS）、吞咽障碍量表（SIS）、颈部障碍量表（NIS）、疤痕问卷（SCAR-Q）]对患者进行评估。
OT 组和 RT 组术后暂时性甲状旁腺功能减退症、永久性甲状旁腺功能减退症和暂时性低钙血症的发生率差异有统计学意义（P <0.001）。两组 SIS 和 VIS 评分差异有统计学意义（P <0.001）。SF-36 在“生理功能”、“身体疼痛”、“一般健康”、“活力”、“社会功能”、“情感角色”和“心理健康”等亚组中，两组间差异有统计学意义（P <0.001）。SCAR-Q 显示两组疤痕的长度和外观差异有统计学意义。
采用超精细包膜剥离的 RT 可以保护甲状旁腺功能，提高术后 QoL，可能成为甲状腺癌机器人辅助手术的新选择。
