[Efficacy analysis of gasless robotic surgery via transaxillary approach for unilateral N1b PTC]
- PMID: 41147172
- DOI: 10.13201/j.issn.2096-7993.2025.11.003
[Efficacy analysis of gasless robotic surgery via transaxillary approach for unilateral N1b PTC]
Abstract
Objective:To compare the efficacy of gasless robotic surgery via transaxillary approach and combined axillary-retroauricular approach for unilateral N1b PTC, and to explore the safety and effectiveness of gasless robotic surgery via transaxillary approach for unilateral N1b PTC. Methods:Unilateral N1b PTC patients who underwent surgery in the Department of Otolaryngology, Sun Yat Sen Memorial Hospital, Sun Yat sen University between July 2016 and December 2024 were included and analyzed. According to the inclusion and exclusion criteria and the differences of surgical approaches, the patients were divided into the transaxillary approach（TA） group and the combined axillary-retroauricular approach（TARA） group. The demographic data, operation time, intraoperative blood loss, postoperative drainage volume, postoperative complications, shoulder function evaluation, postoperative visual analogue scale（VAS） of neck aesthetics and recurrence of the two groups were statistically analyzed. Results:A total of 88 patients undergoing gasless robotic surgery were included in this study, including 23 cases in the TA group and 65 cases in the TARA group. The proportion of males in the TA group was significantly higher than that in the TARA group（56.5% vs 21.5%, χ²=9.776, P=0.002）. The total operation time in the TA group was significantly lower than that in the TARA Group（180.00[155.00, 220.00]min vs 220.00[177.50, 272.50]min, z=-2.775, P=0.006）, and the postoperative blood loss in the TA group was significantly lower than that in the TARA Group（30.00[20.00, 50.00]ml vs 50.00[30.00, 60.00]ml, Z=-2.127, P=0.033）. The proportion of area Ⅱ-Ⅴ in the TA group and the TARA group was 87.0% and 70.8%, respectively, and there was no significant difference between the two groups（P>0.05）. There was no significant difference in lateral cervical lymph node dissection and central lymph node dissection between the two groups（P>0.05）. During the follow-up period, no recurrence was found in the two groups, and there was no significant difference in the incidence of complications between the two groups（P>0.05）. According to the stratification of dynamic recurrence risk assessment, it can be seen that the proportion of curative effect satisfaction in the TA group was as high as 95.7%, and that in the TARA group was as high as 81.5%, with no significant difference between the two groups. There was no significant difference in VAS score of neck, Constant Shoulder Score and NDⅡ scale between the two groups（P>0.05）. Conclusion:Gasless robotic surgery via transaxillary approach for unilateral N1b PTC is safe and feasible, and the amount postoperative lymph node acquisition is equivalent to that of combined axillary-retroauricular approach, which can provide a new choice for the treatment of unilateral N1b PTC patients.
目的：比较免注气腋窝入路及腋窝联合耳后入路机器人手术治疗单侧N1b PTC的疗效，探索免注气腋窝入路机器人手术对单侧N1b PTC的安全性和有效性。 方法：收集2016年7月至2024年12月于中山大学孙逸仙纪念医院耳鼻咽喉科接受手术治疗的单侧N1b PTC患者进行分析。根据纳入和排除标准以及手术入路的差异，将患者划分为腋窝组和腋窝联合耳后组，并对2组患者的人口学数据、手术时间、术中出血量、术后引流量、术后并发症、肩功能评估、术后颈部美观视觉模拟量表（VAS）以及复发情况等进行统计学分析。 结果：本研究共纳入88例免注气机器人手术患者，其中腋窝组有23例，腋窝联合耳后组65例。腋窝组男性比例显著高于腋窝联合耳后组（56.5% vs 21.5%，χ²=9.776，P=0.002）。腋窝组总手术时间显著低于腋窝联合耳后组[180.00（155.00，220.00） min vs 220.00（177.50，272.50） min，Z=-2.775，P=0.006]，同时腋窝组术后出血量显著低于腋窝联合耳后组[30.00（20.00，50.00） min vs 50.00（30.00，60.00） min，z=-2.127，P=0.033]。腋窝组及腋窝联合耳后组清扫范围为Ⅱ～Ⅴ区的比例分别为87.0%及70.8%，2组差异无统计学意义（P>0.05）。2组的侧颈区淋巴结清扫和中央区淋巴结清扫情况差异无统计学意义（P>0.05）。在随访期间2组患者均未见复发病例，2组患者并发症发生情况均差异无统计学意义（P>0.05）。根据动态复发风险评估分层，可以看到腋窝组疗效满意比例达95.7%，腋窝联合耳后组比例达81.5%，2组差异无统计学意义。2组的颈部美观VAS评分及Constant肩功能量表及NDⅡ量表评估2组均差异无统计学意义（P>0.05）。 结论：免注气腋窝入路机器人手术治疗单侧N1b PTC安全可行，术后淋巴结获取量及疗效与机器人联合入路手术相当，可为合适的单侧N1b PTC患者的治疗提供一种新选择。.
Keywords: efficacy; gasless; papillary thyroid carcinoma; robotic surgery; transaxillary approach.
Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.
Conflict of interest statement
The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose.