A meta-analysis of unilateral axillary approach for robotic surgery compared with open surgery for differentiated thyroid carcinoma

Abstract

Objective: The Da Vinci Robot is the most advanced micro-control system in endoscopic surgical instruments and has gained a lot of valuable experience today. However, the technical feasibility and oncological safety of the robot over open surgery are still uncertain. This work is to systematically evaluate the efficacy of the unilateral axillary approach for robotic surgery compared to open surgery for differentiated thyroid carcinoma.

Methods: PubMed, Embase, Cochrane Library, and Web of Science databases were utilized to search for relevant literatures of robotic thyroid surgery using unilateral axillary approach compared to open thyroid surgery, and a meta-analysis was performed using RevMan software version 5.3. Statistical analysis was performed through Mantle-Haenszel and inverse variance methods.

Results: Twelve studies with a total of 2660 patients were included in the meta-analysis. The results showed that compared with the open group, the robotic group had a longer total thyroidectomy time, shorter hospital stay, less intraoperative bleeding, more postoperative drainage, fewer retrieved central lymph nodes, and higher cosmetic satisfaction (all P < 0.05). In contrast, temporary and permanent laryngeal recurrent nerve injury, temporary and permanent hypoparathyroidism or hypocalcemia, brachial plexus nerve injury, number of retrieved central lymph nodes, number of retrieved lymph nodes in the lateral cervical region, number of lymph node metastases in the lateral cervical region, hematoma, seroma, lymphatic leak, stimulated thyroglobulin (sTg) and unstimulated thyroglobulin (uTg), and the number and recurrence rate of patients with sTg <1ng/ml were not statistically different between the two groups (P > 0.05).

Conclusions: The unilateral axillary approach for robotic thyroid surgery may achieve outcomes similar to those of open surgery. Further validation is required in a prospective randomized controlled trial.

Fig 1. Flow diagram of the study selection.

Fig 2. Forest plots displaying incidences of (A) transient recurrent laryngeal nerve injury; (B) permanent recurrent laryngeal nerve injury; (C) brachial plexus nerve injury.

RT, robotic thyroidectomy; OT, open thyroidectomy; M-H, Mantel–Haenszel; CI, confidence interval.

Fig 3

Forest plots displaying incidences of (A) transient hypocalcemia or hypoparathyroidism; (B) permanent hypocalcemia or hypoparathyroidism; (C) hematoma; (D) seroma; (E) lymphatic leakage RT, robotic thyroidectomy; OT, open thyroidectomy; M-H, Mantel–Haenszel; CI, confidence interval.

Fig 4

Forest plots displaying number of (A) retrieved central lymph nodes; (B) central lymph node metastases; (C) retrieved lymph nodes in the lateral cervical region; (D) metastatic lymph nodes retrieved from the lateral component RT, robotic thyroidectomy; OT, open thyroidectomy; SD, standard deviation; CI, confidence interval; IV, inverse variance.

Fig 5

Forest plots displaying (A) operative time of total thyroidectomy; (B) length of hospitalization; (C) drain amount; (D) amount of intraoperative bleeding RT, robotic thyroidectomy; OT, open thyroidectomy; SD, standard deviation; CI, confidence interval; IV, inverse variance; TT, total thyroidectomy; CCND, central component lymph node dissection; MRND, modified radical lymph node dissection.

Fig 6

Forest plots displaying (A) sTg; (B) number of sTg<1ng/ml; (C) uTg; (D) recurrence rate; (E) cosmetic satisfaction RT, robotic thyroidectomy; OT, open thyroidectomy; SD, standard deviation; CI, confidence interval; IV, Inverse Variance.