Tae, Kyung1; Song, Chang Myeon1; Jang, Younil1; Ji, Yong Bae1; Park, Woosung1; Lee, Dong Won1
1 Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Korea
Background: The purpose of this study was to evaluate the factors related with operative time in robotic thyroidectomy.
Methods: We retrospectively analyzed 240 patients with thyroid nodule(s) who underwent robotic thyroidectomy with and without central neck dissection (CND) via a gasless unilateral axillary or axillo-breast approach. We evaluated the operative time in sequence of operative date and analyzed the learning curve for robotic thyroidectomy. After excluding the cases within the learning curve, patients were subcategorized into those with long operative time (upper 25% cases, LOT) and those with short operative time (lower 25%, SOT) among total thyroidectomy cases and lobectomy cases, respectively. Factors including the clinicopathologic data, perioperative complication rates, and surgical outcomes, were analyzed to determine the factors affecting the operative time using a logistic regression multivariate analysis.
Results: The learning curve was 30-35 cases. In total thyroidectomy cases, factors that were significantly different between the LOT (n=30) and SOT (n=30) groups in multivariate logistic regression analysis were body mass index (BMI)?23 Kg/m2 (HR 5.34, P = 0.008) and bilateral CND (HR 14.92, P = 0.028). In lobectomy cases, multivariate analysis showed that BMI ? 23 Kg/m2 (HR 12.92, P = 0.003) and unilateral CND (HR 21.38, P = 0.017) were both independent risk factors for prolonged operative time.
Conclusion: High BMI and the extent of CND significantly prolonged operative time of robotic thyroidectomy by a gasless unilateral transaxillary approach. Body habitus and clinical nodal status in the central compartment should be considered in deciding the indications for robotic thyroidectomy.