Our Summary

This research paper examines a surgical procedure called robotic transaxillary thyroidectomy, which is a method to remove the thyroid gland. This technique was first pioneered in South Korea and is widely used in the Far East, but is less common and somewhat controversial in Western countries. This could be due to cultural and physical differences between populations, and the fact that thyroid nodules in South Korea tend to be smaller due to a national thyroid cancer screening program.

The paper provides evidence that this robotic procedure is just as safe and effective as traditional open surgery when it comes to avoiding injury to the recurrent laryngeal nerve, avoiding hypoparathyroidism (a condition that results when the parathyroid glands in the neck produce too little parathyroid hormone), preventing bleeding, and achieving good results for patients with differentiated thyroid cancer. In fact, the robotic approach may be even better than open surgery in certain areas, such as leaving less visible scarring and causing less pain.

However, there are some downsides to the robotic procedure. It is more expensive and takes longer than open surgery. There is also a risk of complications that do not occur with open surgery, such as temporary damage to the nerves in the arm.

The paper emphasizes that it’s important to carefully select which patients are suitable for this procedure. Not every patient, surgeon, or hospital is a good fit. The procedure should only be performed by very experienced surgeons who are part of a specialized team that uses robots in surgery.

The paper also mentions new robotic techniques that use different routes to access the thyroid gland, but additional research is needed to determine their role in modern thyroid surgery.

FAQs

  1. What is robotic transaxillary thyroidectomy and where was it pioneered?
  2. What are the advantages of robotic thyroidectomy over open surgery?
  3. What are the downsides of robotic thyroidectomy and who should perform this procedure?

Doctor’s Tip

A helpful tip a doctor might tell a patient about robotic surgery is to ensure they are being treated by a high-volume surgeon operating as part of a multidisciplinary robotic team in a specialized center. This will help ensure the best possible outcome for the patient. It is also important for patients to carefully consider the benefits and potential risks of robotic surgery compared to traditional open surgery.

Suitable For

Patients who are typically recommended robotic surgery for thyroidectomy are those with smaller thyroid nodules, differentiated thyroid cancer, and who value improved scar cosmesis and reduced pain postoperatively. Additionally, patients who are willing to undergo a longer operation with higher costs in exchange for potential benefits in outcomes may also be recommended for robotic surgery. It is important for patients to be carefully selected and for the procedure to be performed by experienced surgeons in specialized centers to ensure optimal outcomes.

Timeline

Before robotic surgery:

  1. Patient presents with thyroid nodules or thyroid cancer symptoms
  2. Patient undergoes consultation with a surgeon to discuss treatment options
  3. Patient undergoes pre-operative tests and evaluations to determine candidacy for robotic surgery
  4. Patient receives education on the robotic surgery procedure and what to expect during and after surgery

After robotic surgery:

  1. Patient undergoes surgery with robotic assistance, typically through a transaxillary approach
  2. Patient experiences minimal scarring and pain compared to traditional open surgery
  3. Patient may stay in the hospital for a shorter period of time and have a quicker recovery
  4. Patient follows up with the surgeon for post-operative care and monitoring of thyroid function
  5. Patient may experience improved cosmetic outcomes and overall satisfaction with the robotic surgery approach.

What to Ask Your Doctor

  1. What are the potential benefits of robotic surgery compared to traditional open surgery for my specific thyroid condition?

  2. What are the risks and potential complications associated with robotic thyroid surgery?

  3. How experienced is the surgical team with robotic thyroid surgery, and what is their success rate?

  4. How long is the recovery time expected to be compared to open surgery?

  5. Will I have a scar after robotic thyroid surgery, and if so, what will it look like?

  6. Will there be any limitations or restrictions on my activities after robotic thyroid surgery?

  7. How will my follow-up care be managed after robotic thyroid surgery?

  8. Are there any alternative treatment options to robotic surgery for my thyroid condition?

  9. What are the costs associated with robotic thyroid surgery, and will my insurance cover it?

  10. Are there any long-term effects or considerations I should be aware of after undergoing robotic thyroid surgery?

Reference

Authors: Aidan P, Arora A, Lorincz B, Tolley N, Garas G. Journal: ORL J Otorhinolaryngol Relat Spec. 2018;80(3-4):186-194. doi: 10.1159/000488354. Epub 2018 May 22. PMID: 29788019