EP100 – Early outcomes in transoral robotic vs. transoral endoscopic thyroid surgery, the Johns Hopkins experience

     

    Razavi, Christopher R.1; Al Khadem, Mai G.1; Richmon Jeremy D.1; Tufano Ralph P.1; Russell, Jonathon O.1
    1 Division of Head and Neck Endocrine Surgery, Department of Otolaryngology – Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Background: The cervical neck incision has long been the primary approach to performing thyroid surgery. 1 Although highly functional, it can result in unsightly neck scarring.2-3 Many alternative approaches have been proposed, including the transoral vestibular approach. 1,4-11

    Objectives: We describe our outcomes via a transoral vestibular approach performed either robotically or endoscopically. We aim to demonstrate the feasibility and safety of both techniques, and comment on our perceived advantages and disadvantages based on our experience.

    Methods: All cases of transoral thyroid surgery performed at Johns Hopkins Hospital were retrospectively reviewed after Institutional Review Board approval. 12 thyroid lobectomies were identified, 6 performed robotically and 6 endoscopically. All cases were for benign disease. Primary outcomes included operative time and presence of persistent nerve injury (either mental or recurrent). One robotic case included both a thyroid lobectomy and parathyroidectomy. This case was not included when calculating mean operative time in the robotic cohort.

    Results: Mean operative time for the endoscopic cohort was 245.5 minutes (SD 57.5 minutes) vs. 360.0 minutes (SD 60.9 minutes) in the robotic cohort.  There were no persistent nerve injuries, mental or recurrent, in either cohort.

    Discussion: The endoscopic technique was significantly (p= .01) faster than robotic technique, while there was no evidence of permanent nerve injury in either cohort. Perceived disadvantages with the endoscopic technique include the need for an assistant to operate the endoscope.

    Conclusion: Thyroid surgery can be safely performed without a cervical incision via both techniques, though more quickly endoscopically.

     

    References:

    1. Adam MA, Speicher P, Pura J, et al. Robotic thyroidectomy for cancer in the US: patterns of use and short-term outcomes. Annals of surgical oncology. Nov 2014;21(12):3859-3864.
    2. Arora A, Swords C, Garas G, et al. The perception of scar cosmesis following thyroid and parathyroid surgery: A prospective cohort study. International journal of surgery. Jan 2016;25:38-43.
    3. Choi Y, Lee JH, Kim YH, et al. Impact of postthyroidectomy scar on the quality of life of thyroid cancer patients. Annals of dermatology. Dec 2014;26(6):693-699.
    4. Benhidjeb T, Wilhelm T, Harlaar J, Kleinrensink GJ, Schneider TA, Stark M. Natural orifice surgery on thyroid gland: totally transoral video-assisted thyroidectomy (TOVAT): report of first experimental results of a new surgical method. Surgical endoscopy. May 2009;23(5):1119-1120.
    5. Richmon JD, Pattani KM, Benhidjeb T, Tufano RP. Transoral robotic-assisted thyroidectomy: a preclinical feasibility study in 2 cadavers. Head & neck. Mar 2011;33(3):330-333.
    6. Clark JH, Kim HY, Richmon JD. Transoral robotic thyroid surgery. Gland surgery. Oct 2015;4(5):429-434.
    7. Miccoli P. Minimally invasive surgery for thyroid and parathyroid diseases. Surgical endoscopy. Jan 2002;16(1):3-6.
    8. Barlehner E, Benhidjeb T. Cervical scarless endoscopic thyroidectomy: Axillo-bilateral-breast approach (ABBA). Surgical endoscopy. Jan 2008;22(1):154-157.
    9. Anuwong A. Transoral Endoscopic Thyroidectomy Vestibular Approach: A Series of the First 60 Human Cases. World journal of surgery. Mar 2016;40(3):491-497.
    10. Dionigi G, Lavazza M, Bacuzzi A, et al. Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA): From A to Z. Surgical Technology International. February 2017;30.
    11. Russell JO, Noureldine SI, Al Khadem MG,  et al. Transoral robotic thyroidectomy: a preclinical feasibility study using the da Vinci Xi platform. Journal of robotic Surgery. February 2017.

 

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  • WCTC3.5 Steering Committee:

     

    Rocco Bellatone, Co-Chair
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    Jeremy Freeman, MD
    Ian J. Witterick, MD
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