Wen Xiaoyong, Zhou Shiwei, Wu Peng, Li Wu, Li Hui, Wang Zhiyuan, Zhang Lu, Li Jigang, Peng Xiaowei
Department of Thyroid Surgery, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, Hunan, P. R. China.
Department of Thyroid Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P. R. China.
J Otolaryngol Head Neck Surg. 2024 Jan-Dec;53:19160216241304384. doi: 10.1177/19160216241304384.
With advancements in robotic surgery, robotic-assisted thyroidectomy is gaining popularity. The introduction of the 3-port transoral robotic thyroidectomy (T-TORT) offers an alternative approach with potential benefits in postoperative recovery compared to traditional methods.
To assess the safety and feasibility of T-TORT in comparison to the transoral endoscopic thyroidectomy vestibular approach (TOETVA).
A retrospective cohort study with 1:1 propensity score matching was conducted to compare perioperative outcomes between T-TORT and TOETVA. The learning curve was analyzed using cumulative summation (CUSUM).
Tertiary A hospital.
One hundred sixty-two patients who underwent either T-TORT or TOETVA were included.
The T-TORT group underwent three-port robotic thyroidectomy, while the TOETVA group received standard transoral vestibular endoscopic thyroidectomy.
Demographics and perioperative data were compared. The learning curve was evaluated using CUSUM.
Compared with the TOETVA group the operation time in minutes of the T-TORT group was relatively longer (136.14 ± 36.52 vs 122.49 ± 34.85, = .012), the postoperative stay, in days, was shorter (2.77 ± 0.78 vs 3.51 ± 0.95, < .001), the drainage volume on a postoperative day 1 (POD1) and POD2, in milliliter, was less (POD1 56.57 ± 23.29 vs 65.12 ± 26.04, = .029 and POD2 27.43 ± 25.29 vs 38.21 ± 25.09, = .008). The other statistics, including bleeding amount, retrieved and metastatic central lymph nodes, visual analog scale score, and drainage volume on an operative day were comparable between the 2 groups. Meanwhile, there were no significant differences between the 2 groups in postoperative complication rates. The turning point of the learning curve was in the 16th case with a hemithyroidectomy with central neck dissection (CND) and the 21st case with a bilateral thyroidectomy with CND.
T-TORT is a safe and feasible option with enhanced postoperative recovery compared to TOETVA. It may be a preferable choice in specific clinical situations.
This study was registered at the Chinese Clinical Trial Registry (UIN: ChiCTR2300069021, https://www.chictr.org.cn) in accordance with the World Medical Association's Declaration of Helsinki, 2013.
随着机器人手术技术的进步，机器人辅助甲状腺切除术越来越受欢迎。三孔经口机器人甲状腺切除术（T-TORT）的引入提供了一种替代方法，与传统方法相比，在术后恢复方面具有潜在优势。
评估T-TORT与经口内镜甲状腺切除术前庭入路（TOETVA）相比的安全性和可行性。
采用倾向评分1:1匹配的回顾性队列研究，比较T-TORT和TOETVA的围手术期结局。使用累积求和（CUSUM）分析学习曲线。
三级甲等医院。
纳入162例行T-TORT或TOETVA的患者。
T-TORT组接受三孔机器人甲状腺切除术，而TOETVA组接受标准经口前庭内镜甲状腺切除术。
比较人口统计学和围手术期数据。使用CUSUM评估学习曲线。
与TOETVA组相比，T-TORT组的手术时间（分钟）相对较长（136.14±36.52 vs 122.49±34.85，P = 0.012），术后住院天数较短（2.77±0.78 vs 3.51±0.95，P < 0.001），术后第1天（POD1）和第2天的引流量（毫升）较少（POD1 56.57±23.29 vs 65.12±26.04，P = 0.029；POD2 27.43±25.29 vs 38.21±25.09，P = 0.008）。其他统计数据，包括出血量、中央区淋巴结清扫数量和转移情况、视觉模拟评分以及手术日引流量，两组之间具有可比性。同时，两组术后并发症发生率无显著差异。学习曲线的转折点分别为第16例单侧甲状腺切除加中央区淋巴结清扫（CND）和第21例双侧甲状腺切除加CND。
与TOETVA相比，T-TORT是一种安全可行的选择，术后恢复更好。在特定临床情况下可能是更优选择。
本研究已按照2013年世界医学协会《赫尔辛基宣言》在中国临床试验注册中心注册（注册号：ChiCTR2300069021，https://www.chictr.org.cn）。
