Unilateral axilla-bilateral areola approach for thyroidectomy by da Vinci robot vs. open surgery in thyroid cancer: a retrospective observational study

Abstract

Background: To compare the efficacy and safety of unilateral axilla-bilateral areola (UABA) approach for robot-assisted thyroidectomy with conventional open surgery in thyroid cancer patients.

Methods: The clinicopathological features and surgical outcomes of 194 thyroid cancer patients treated by robotic surgery using the UABA approach and 217 patients treated by open surgery in our department from January 2017 to August 2018 were analysed and compared.

Results: The operation time was longer in the robotic group than in the open surgery group. The patients' satisfaction with neck appearance was higher in the robotic group than in the open surgery group (91.2% vs. 21.6%, P<0.01). After total thyroidectomy and central lymph node dissection, the incidence of postoperative transient hypoparathyroidism and postoperative permanent hypoparathyroidism in the open surgery group was 29.7% (44/148) and 6.8% (10/148), higher than that [17.9% (27/151) and 2.0% (3/151)] in the robotic group (P<0.05 respectively). No significant difference was observed in the number of dissected lymph nodes or postoperative serum thyroglobulin (TG) levels or incidence of transient or permanent hoarseness of voice between the two groups. No recurrence or metastasis was found.

Conclusions: Compared with open surgery, UABA robotic surgery preserved the neck appearance and effectively reduced hypoparathyroidism by super-meticulous capsular dissection (SMCD).

Keywords: Thyroid cancer surgery; da Vinci robot; open surgery; super-meticulous capsular dissection (SMCD); unilateral axilla-bilateral areola approach (UABA approach).

Figure 1

The incision sites were marked on the right axilla and in the medial margin of the bilateral areolae, and the line from each incision site to the superior border of the inner clavicle and right and left sternoclavicular joints, respectively, were used to guide the trajectory of the trocars.

Figure 2

The strap muscle was drawn to the right and the trachea was drawn to the left using thyroid retractors to expose the right median area for central lymph node dissection. After dissection, the periphery structure was clear: the trachea (blue arrow), the right superior parathyroid gland (green arrow), the recurrent laryngeal nerve (yellow arrow), and the cervical artery (black arrow).

Figure 3

The strap muscle was drawn to the left and the trachea was drawn to the right using thyroid retractors to expose the left median area for central lymph node dissection. After dissection, the periphery structure was clear: the right superior parathyroid gland (green arrow), the recurrent laryngeal nerve (yellow arrow), the esophagus (red arrow), the trachea (blue arrow), and the left common carotid artery (black arrow).