Sialakis Christos, Frantzana Aikaterini, Iliadis Christos, Ouzounakis Petros, Antoniou Sialaki Panagiota, Kourkouta Lambrini
Otolaryngology, Private Diagnostic Health Center, Thessaloniki, GRC.
Epidemiology and Public Health, George Papanikolaou General Hospital of Thessaloniki, Thessaloniki, GRC.
Cureus. 2024 Feb 8;16(2):e53860. doi: 10.7759/cureus.53860. eCollection 2024 Feb.
This review aims to investigate the safety of recurrent laryngeal nerve (RLN) by comparing robotic thyroidectomy (RT) versus open thyroidectomy (OT) in Western and Asian populations. Two main outcomes of this review were (1) the safety of RLN comparing the robotic and OT assessing transient and permanent laryngeal nerve (PLN) palsy as a postoperative complication in each surgical procedure and (2) the safety of RLN comparing the robotic and OT assessing transient and permanent laryngeal nerve (PLN) palsy as a postoperative complication between studies conducted in USA/Europe and Asia. We searched relevant literature in electronic databases such as PubMed, MEDLINE, Cochrane CENTRAL, ScienceDirect, and Cumulative Index to Nursing & Allied Health (CINAHL) up to September 2022. Further research was performed during January 2024 in the Scopus database. Two primary outcomes were set: transient RLN palsy and permanent RLN palsy, comparing RT and OT. In this review, 18 non-randomized studies were included. A statistically significant difference between robotic and conventional OT was not observed either in transient RLN or in permanent RLN palsy. The odds ratio (OR) for the overall comparison of transient RLN palsy was 1.18, and the 95% confidence interval (95% CI) was 0.80-1.74. The subgroup analysis for transient RLN palsy between USA/Europe studies was OR 1.28, and the 95% CI was 0.64-2.58. The subgroup analysis for transient RLN palsy between Asian studies was OR 1.14, and the 95% CI was 0.72-1.82. The OR for the overall comparison of permanent RLN palsy was OR 0.90, and the 95% CI was 0.38-2.15. The subgroup analysis for permanent RLN palsy between USA/Europe studies was OR 0.45, and the 95% CI was 0.07-2.97. The subgroup analysis for permanent RLN palsy between Asian studies was OR 1.13, and the 95% CI was 0.42-3.05. Heterogeneity Iwas 0% in all outcomes. The Mantel-Haenszel method fixed effect was used. First, RT and open conventional thyroidectomy have comparable safety for RLN, although the analysis showed no statistically significant results. Second, no statistically significant results were found for RLN safety in either USA/Europe or Asian studies. Considering that there is not a statistically significant difference between the two approaches for RLN safety, and due to the limited number of studies from Western countries, the results should be considered with caution. Important factors such as the patient's body characteristics, the existing thyroid pathology, and the surgical approach should be kept in mind. More comparable studies are needed on the Western population.
本综述旨在通过比较西方和亚洲人群中机器人甲状腺切除术（RT）与开放性甲状腺切除术（OT），研究喉返神经（RLN）的安全性。本综述的两个主要结果是：（1）比较机器人手术和开放性手术时RLN的安全性，评估每种手术中作为术后并发症的暂时性和永久性喉返神经麻痹（PLN）；（2）比较机器人手术和开放性手术时RLN的安全性，评估在美国/欧洲和亚洲进行的研究之间作为术后并发症的暂时性和永久性喉返神经麻痹（PLN）。我们在PubMed、MEDLINE、Cochrane CENTRAL、ScienceDirect和护理及相关健康累积索引（CINAHL）等电子数据库中检索了截至2022年9月的相关文献。2024年1月在Scopus数据库中进行了进一步研究。设定了两个主要结果：比较RT和OT时的暂时性RLN麻痹和永久性RLN麻痹。本综述纳入了18项非随机研究。在暂时性RLN或永久性RLN麻痹方面，未观察到机器人手术与传统开放性手术之间存在统计学显著差异。暂时性RLN麻痹总体比较的比值比（OR）为1.18，95%置信区间（95%CI）为0.80 - 1.74。美国/欧洲研究中暂时性RLN麻痹的亚组分析OR为1.28，95%CI为0.64 - 2.58。亚洲研究中暂时性RLN麻痹的亚组分析OR为1.14，95%CI为0.72 - 1.82。永久性RLN麻痹总体比较的OR为0.90，95%CI为0.38 - 2.15。美国/欧洲研究中永久性RLN麻痹的亚组分析OR为0.45，95%CI为0.07 - 2.97。亚洲研究中永久性RLN麻痹的亚组分析OR为1.13，95%CI为0.42 - 3.05。所有结果的异质性均为0%。采用Mantel - Haenszel方法固定效应。首先，尽管分析未显示统计学显著结果，但RT和开放性传统甲状腺切除术对RLN的安全性相当。其次，在美国/欧洲或亚洲的研究中，RLN安全性均未发现统计学显著结果。鉴于两种方法在RLN安全性方面无统计学显著差异，且西方国家的研究数量有限，应谨慎考虑这些结果。应牢记患者身体特征、现有甲状腺病理情况和手术方式等重要因素。需要对西方人群进行更多可比研究。
