Experience with Robotic Thyroid Surgery in North American Patients

What is the feasibility of robotic thyroid surgery in North American patients?

Background: Less invasive thyroid surgery approaches, such as video-assisted thyroidectomy, may be technically difficult and still result in a neck incision. The daVinci Surgical System has been applied to a transaxillary endoscopic approach to the thyroid, allowing increased precision, tremor filtration and more degrees of freedom. A group in Seoul, South Korea has found gasless transaxillary robot-assisted endoscopic thyroid surgery to be safe and feasible.

Study design: Retrospective review of first 31 cases at a single center.

Setting: Texas Institute for Thyroid and Parathyroid Surgery, College Station, Texas; Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston.

Synopsis: After observing the Seoul group, training on the procedure and doing cadaver dissection, the Texas researchers performed gasless transaxillary robot-assisted endoscopic thyroid surgery on 31 North American patients. The team found modifications were needed for North Americans, who are less homogeneous than Koreans with respect to body shape, size and incidence of obesity. For example, the creation of the working space is technically more difficult in larger patients. A learning curve was needed; the authors noted that training paradigms have not been validated and uniform credentialing standards do not exist. The surgical approach required multiple steps and a team approach. The authors said strict criteria for the limits of what can be accomplished through this approach have not been determined, and the indications and contraindications need better delineation. One theoretical concern was the ability to safely remove the entire contralateral side of the thyroid in total thyroidectomy through an ipsilateral incision and the ability to visualize the contralateral recurrent laryngeal nerve and parathyroids. Contingency plans are needed for potential intraoperative complications such as hemorrhage or robotic system failure.

Bottom line: Robotic thyroid surgery is feasible in North American patients and can be safely performed.

Citation: Kuppersmith RB, Holsinger FC. Robotic thyroid surgery: an initial experience with North American patients. Laryngoscope. 2011;121(3):521-526.

—Reviewed by Sue Pondrom