Robotic surgery for thyroid disease

Abstract

Robotic surgery is an innovation in thyroid surgery that may compensate for the drawbacks of conventional endoscopic surgery. A surgical robot provides strong advantages, including three-dimensional imaging, motion scaling, tremor elimination, and additional degrees of freedom. We review here recent adaptations, experience and applications of robotics in thyroid surgery. Robotic thyroid surgeries include thyroid lobectomy, total thyroidectomy, central compartment neck dissection, and radical neck dissection for benign and malignant thyroid diseases. Most of the current literature consists of case series of robotic thyroidectomies. Recent retrospective and prospective analyses have evaluated the safety and oncologic efficacy of robotic surgery for thyroid cancer. Although robotic thyroid surgery is often associated with longer operation times than conventional open surgery, robotic techniques have shown similar or superior levels of surgical completeness and safety compared with conventional open or endoscopic surgery. Compared to open thyroidectomy, robotic thyroidectomy has been associated with several quality-of-life benefits, including excellent cosmetic results, reduced neck pain and sensory changes, and decreased voice and swallowing discomfort after surgery. For surgeons, robotic surgery has improved ergonomics and has a shorter learning curve than open or endoscopic surgery. The advantages of robotic thyroid surgery over conventional surgery suggest that robotic thyroidectomy with or without neck dissection may become the preferred surgical option for thyroid diseases. Robotic thyroid surgery will likely continue to develop as more endocrine and head-and-neck surgeons are trained and more patients seek this newly developed surgical option.

Keywords: Neck dissection; Robot; Robotic neck dissection; Robotic thyroidectomy; Thyroid; Thyroidectomy.

Fig. 1

Single-incision robotic thyroidectomy. All four robotic instruments and the camera were placed through the axillary incision [source: [26]].

Fig. 2

Positions following a correct final external setup of the robot. a A Maryland dissection, the camera arm and ProGrasp arm should form an inverted triangle external to the insertion axis. b The instrument and camera tips should form a normal triangle internally to the site of operation.

Fig. 3

Immediate postoperative scar after robotic thyroidectomy.

Fig. 4

Postoperative scar immediately after bilateral robotic mRND in a PTC patient showing bilateral lateral neck node metastasis.