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:
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