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Published in: Surgical Endoscopy 11/2012

01-11-2012

A comparative study of the surgical outcomes of robotic and conventional open modified radical neck dissection for papillary thyroid carcinoma with lateral neck node metastasis

Authors: Sang-Wook Kang, So Hee Lee, Jae Hyun Park, Jun Soo Jeong, Seulkee Park, Cho Rok Lee, Jong Ju Jeong, Kee-Hyun Nam, Woong Youn Chung, Cheong Soo Park

Published in: Surgical Endoscopy | Issue 11/2012

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Abstract

Background

Several endoscopic modified radical neck dissections (MRND) have been conducted since the introduction of the endoscopic technique to thyroid surgery with the aim of avoiding a long cervical scar. Furthermore, the recent introduction of surgical robotic systems has increased the precision of endoscopic techniques. The aim of this study was to evaluate and compare the early surgical outcomes of robotic and conventional open MRND for papillary thyroid carcinoma (PTC) with lateral neck node metastasis (LNM).

Methods

From January 2009 to May 2010, 165 patients with PTC underwent bilateral total thyroidectomy with central compartment neck dissection and ipsilateral MRND. Of these patients, 56 formed the robotic procedure group (RG) and 109 the conventional open procedure group. These two groups were retrospectively compared with respect to their clinicopathological characteristics, early surgical outcomes, and surgical completeness.

Results

The operative time was longer, mean tumor size was smaller, mean age was lower, and disease stage was earlier in the RG. However, mean numbers of retrieved lymph nodes were similar in the two groups, and mean hospital stay after surgery was shorter in the RG. Furthermore, complication rates were similar in the two groups, and there was no statistical difference in postoperative Tg levels between the groups.

Conclusions

Robotic MRND was found to be similar to conventional open MRND in terms of early surgical outcomes and surgical completeness but leaves no scar on the neck area. Robotic MRND can be viewed as an acceptable alternative method in low-risk PTC with LNM.
Literature
1.
go back to reference Gosnell JE, Clark OH (2008) Surgical approaches to thyroid tumors. Endocrinol Metab Clin North Am 37:437–455PubMedCrossRef Gosnell JE, Clark OH (2008) Surgical approaches to thyroid tumors. Endocrinol Metab Clin North Am 37:437–455PubMedCrossRef
2.
go back to reference Hundahl SA, Cady B, Cunningham MP, Mazzaferri E, McKee RF, Rosai J, Shah JP, Fremgen AM, Stewart AK, Hölzer S (2000) Initial results from a prospective cohort study of 5583 cases of thyroid carcinoma treated in the United States during 1996. U.S. and German Thyroid Cancer Study Group. Cancer 89:202–217PubMedCrossRef Hundahl SA, Cady B, Cunningham MP, Mazzaferri E, McKee RF, Rosai J, Shah JP, Fremgen AM, Stewart AK, Hölzer S (2000) Initial results from a prospective cohort study of 5583 cases of thyroid carcinoma treated in the United States during 1996. U.S. and German Thyroid Cancer Study Group. Cancer 89:202–217PubMedCrossRef
3.
go back to reference Caron NR, Clark OH (2005) Papillary thyroid cancer: surgical management of lymph node metastases. Curr Treat Options Oncol 6(4):311–322PubMedCrossRef Caron NR, Clark OH (2005) Papillary thyroid cancer: surgical management of lymph node metastases. Curr Treat Options Oncol 6(4):311–322PubMedCrossRef
4.
go back to reference Lombardi CP, Raffaelli M, Princi P, De Crea C, Bellantone R (2007) Minimally invasive video-assisted functional lateral neck dissection for metastatic papillary thyroid carcinoma. Am J Surg 193:114–118PubMedCrossRef Lombardi CP, Raffaelli M, Princi P, De Crea C, Bellantone R (2007) Minimally invasive video-assisted functional lateral neck dissection for metastatic papillary thyroid carcinoma. Am J Surg 193:114–118PubMedCrossRef
5.
go back to reference Kang SW, Jeong JJ, Yun JS, Sung TY, Lee SC, Lee YS, Nam KH, Chang HS, Chung WY, Park CS (2009) Gasless endoscopic thyroidectomy using trans-axillary approach; surgical outcome of 581 patients. Endocr J 56(3):361–369PubMedCrossRef Kang SW, Jeong JJ, Yun JS, Sung TY, Lee SC, Lee YS, Nam KH, Chang HS, Chung WY, Park CS (2009) Gasless endoscopic thyroidectomy using trans-axillary approach; surgical outcome of 581 patients. Endocr J 56(3):361–369PubMedCrossRef
6.
go back to reference Kang SW, Jeong JJ, Yun JS, Sung TY, Lee SC, Lee YS, Nam KH, Chang HS, Chung WY, Park CS (2009) Robot-assisted endoscopic surgery for thyroid cancer: experience with the first 100 patients. Surg Endosc 23:2399–2406PubMedCrossRef Kang SW, Jeong JJ, Yun JS, Sung TY, Lee SC, Lee YS, Nam KH, Chang HS, Chung WY, Park CS (2009) Robot-assisted endoscopic surgery for thyroid cancer: experience with the first 100 patients. Surg Endosc 23:2399–2406PubMedCrossRef
7.
go back to reference Kang SW, Jeong JJ, Nam KH, Chang HS, Chung WY, Park CS (2009) Robot-assisted endoscopic thyroidectomy for thyroid malignancies using a gasless transaxillary approach. J Am Coll Surg 209(2):e1–e7PubMedCrossRef Kang SW, Jeong JJ, Nam KH, Chang HS, Chung WY, Park CS (2009) Robot-assisted endoscopic thyroidectomy for thyroid malignancies using a gasless transaxillary approach. J Am Coll Surg 209(2):e1–e7PubMedCrossRef
8.
go back to reference Kang SW, Lee SC, Lee SH, Lee KY, Jeong JJ, Lee YS, Nam KH, Chang HS, Chung WY, Park CS (2009) Robotic thyroid surgery using a gasless, transaxillary approach and the da Vinci S system: the operative outcomes of 338 consecutive patients. Surgery 146(6):1048–1055PubMedCrossRef Kang SW, Lee SC, Lee SH, Lee KY, Jeong JJ, Lee YS, Nam KH, Chang HS, Chung WY, Park CS (2009) Robotic thyroid surgery using a gasless, transaxillary approach and the da Vinci S system: the operative outcomes of 338 consecutive patients. Surgery 146(6):1048–1055PubMedCrossRef
9.
go back to reference Ryu HR, Kang SW, Lee SH, Lee KY, Jeong JJ, Nam KH, Chung WY, Park CS (2010) Feasibility and safety of a new robotic thyroidectomy through a gasless, transaxillary single-incision approach. J Am Coll Surg 211(3):e13–e19PubMedCrossRef Ryu HR, Kang SW, Lee SH, Lee KY, Jeong JJ, Nam KH, Chung WY, Park CS (2010) Feasibility and safety of a new robotic thyroidectomy through a gasless, transaxillary single-incision approach. J Am Coll Surg 211(3):e13–e19PubMedCrossRef
10.
go back to reference Kang SW, Lee SH, Ryu HR, Lee KY, Jeong JJ, Nam KH, Chung WY, Park CS (2010) Initial experience with robot-assisted modified radical neck dissection for the management of thyroid carcinoma with lateral neck node metastasis. Surgery 148(6):1214–1221PubMedCrossRef Kang SW, Lee SH, Ryu HR, Lee KY, Jeong JJ, Nam KH, Chung WY, Park CS (2010) Initial experience with robot-assisted modified radical neck dissection for the management of thyroid carcinoma with lateral neck node metastasis. Surgery 148(6):1214–1221PubMedCrossRef
11.
go back to reference Choi JS, Kim J, Kwak JY, Kim MJ, Chang HS, Kim EK (2009) Preoperative staging of papillary thyroid carcinoma: comparison of ultrasound imaging and CT. AJR Am J Roentgenol 193:871–878PubMedCrossRef Choi JS, Kim J, Kwak JY, Kim MJ, Chang HS, Kim EK (2009) Preoperative staging of papillary thyroid carcinoma: comparison of ultrasound imaging and CT. AJR Am J Roentgenol 193:871–878PubMedCrossRef
12.
go back to reference Kim MJ, Kim EK, Kim BM, Kwak JY, Lee EJ, Park CS, Cheong WY, Nam KH (2009) Thyroglobulin measurement in fine-needle aspirate washouts: the criteria for neck node dissection for patients with thyroid cancer. Clin Endocrinol (Oxf) 70(1):145–151CrossRef Kim MJ, Kim EK, Kim BM, Kwak JY, Lee EJ, Park CS, Cheong WY, Nam KH (2009) Thyroglobulin measurement in fine-needle aspirate washouts: the criteria for neck node dissection for patients with thyroid cancer. Clin Endocrinol (Oxf) 70(1):145–151CrossRef
13.
go back to reference Lee J, Sung TY, Nam KH, Chung WY, Soh EY, Park CS (2008) Is level IIb lymph node dissection always necessary in N1b papillary thyroid carcinoma patients? World J Surg 32(5):716–721PubMedCrossRef Lee J, Sung TY, Nam KH, Chung WY, Soh EY, Park CS (2008) Is level IIb lymph node dissection always necessary in N1b papillary thyroid carcinoma patients? World J Surg 32(5):716–721PubMedCrossRef
14.
go back to reference Caron NR, Tan YY, Ogilvie JB, Triponez F, Reiff ES, Kebebew E, Duh QY, Clark OH (2006) Selective modified radical neck dissection for papillary thyroid cancer—Is level I, II and V dissection always necessary? World J Surg 30(5):833–840PubMedCrossRef Caron NR, Tan YY, Ogilvie JB, Triponez F, Reiff ES, Kebebew E, Duh QY, Clark OH (2006) Selective modified radical neck dissection for papillary thyroid cancer—Is level I, II and V dissection always necessary? World J Surg 30(5):833–840PubMedCrossRef
15.
go back to reference Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL (2009) Thyroid. In: Hanks JB, Salomone LJ (eds) Sabiston textbook of surgery, 18th edn. Elsevier, Waltham, pp 917–954 Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL (2009) Thyroid. In: Hanks JB, Salomone LJ (eds) Sabiston textbook of surgery, 18th edn. Elsevier, Waltham, pp 917–954
16.
go back to reference Crile GW (1905) On the surgical treatment of cancer of the head and neck. With a summary of one hundred and five patients. Trans South Surg Gynecol Assoc 18:109–127 Crile GW (1905) On the surgical treatment of cancer of the head and neck. With a summary of one hundred and five patients. Trans South Surg Gynecol Assoc 18:109–127
18.
go back to reference Jesse RH, Ballantyne AJ, Larson D (1978) Radical or modified neck dissection: a therapeutic dilemma. Am J Surg 136:516–519PubMedCrossRef Jesse RH, Ballantyne AJ, Larson D (1978) Radical or modified neck dissection: a therapeutic dilemma. Am J Surg 136:516–519PubMedCrossRef
19.
go back to reference Yoon JH, Park CH, Chung WY (2006) Gasless endoscopic thyroidectomy via an axillary approach: experience of 30 cases. Surg Laparosc Endosc Percutaneous Tech 16:226–231CrossRef Yoon JH, Park CH, Chung WY (2006) Gasless endoscopic thyroidectomy via an axillary approach: experience of 30 cases. Surg Laparosc Endosc Percutaneous Tech 16:226–231CrossRef
20.
go back to reference Ikeda Y, Takami H, Niimi M, Kan S, Sasaki Y, Takayama J (2002) Endoscopic thyroidectomy and parathyroidectomy by the axillary approach. A preliminary report. Surg Endosc 16:92–95PubMedCrossRef Ikeda Y, Takami H, Niimi M, Kan S, Sasaki Y, Takayama J (2002) Endoscopic thyroidectomy and parathyroidectomy by the axillary approach. A preliminary report. Surg Endosc 16:92–95PubMedCrossRef
21.
go back to reference Miccoli P, Elisei R, Materazzi G, Capezzone M, Galleri D, Pacini F, Berti P, Pinchera A (2002) Minimally invasive video-assisted thyroidectomy for papillary carcinoma: a prospective study of its completeness. Surgery 132:1070–1074PubMedCrossRef Miccoli P, Elisei R, Materazzi G, Capezzone M, Galleri D, Pacini F, Berti P, Pinchera A (2002) Minimally invasive video-assisted thyroidectomy for papillary carcinoma: a prospective study of its completeness. Surgery 132:1070–1074PubMedCrossRef
22.
go back to reference Lee KE, Rao J, Youn YK (2009) Endoscopic thyroidectomy with the da Vinci robot system using the bilateral axillary breast approach (BABA) technique: our initial experience. Surg Laparosc Endosc Percutaneous Tech 19(3):e71–e75CrossRef Lee KE, Rao J, Youn YK (2009) Endoscopic thyroidectomy with the da Vinci robot system using the bilateral axillary breast approach (BABA) technique: our initial experience. Surg Laparosc Endosc Percutaneous Tech 19(3):e71–e75CrossRef
23.
go back to reference Holsinger FC, Sweeney AD, Jantharapattana K, Salem A, Weber RS, Chung WY, Lewis CM, Grant DG (2010) The emergence of endoscopic head and neck surgery. Curr Oncol Rep 12(3):216–222PubMedCrossRef Holsinger FC, Sweeney AD, Jantharapattana K, Salem A, Weber RS, Chung WY, Lewis CM, Grant DG (2010) The emergence of endoscopic head and neck surgery. Curr Oncol Rep 12(3):216–222PubMedCrossRef
24.
go back to reference Lewis CM, Chung WY, Holsinger FC (2010) Feasibility and surgical approach of transaxillary robotic thyroidectomy without CO(2) insufflation. Head Neck 32(1):121–126PubMed Lewis CM, Chung WY, Holsinger FC (2010) Feasibility and surgical approach of transaxillary robotic thyroidectomy without CO(2) insufflation. Head Neck 32(1):121–126PubMed
25.
go back to reference Landry CS, Grubbs EG, Perrier ND (2010) Bilateral robotic-assisted transaxillary surgery. Arch Surg 145(8):717–720PubMedCrossRef Landry CS, Grubbs EG, Perrier ND (2010) Bilateral robotic-assisted transaxillary surgery. Arch Surg 145(8):717–720PubMedCrossRef
26.
go back to reference Berber E, Heiden K, Akyildiz H, Milas M, Mitchell J, Siperstein A (2010) Robotic transaxillary thyroidectomy: report of 2 cases and description of the technique. Surg Laparosc Endosc Percutaneous Tech 20(2):e60–e63CrossRef Berber E, Heiden K, Akyildiz H, Milas M, Mitchell J, Siperstein A (2010) Robotic transaxillary thyroidectomy: report of 2 cases and description of the technique. Surg Laparosc Endosc Percutaneous Tech 20(2):e60–e63CrossRef
27.
go back to reference Lang BH, Chow MP (2011) A comparison of surgical outcomes between endoscopic and robotically assisted thyroidectomy: the authors’ initial experience. Surg Endosc 25(5):1617–1623PubMedCrossRef Lang BH, Chow MP (2011) A comparison of surgical outcomes between endoscopic and robotically assisted thyroidectomy: the authors’ initial experience. Surg Endosc 25(5):1617–1623PubMedCrossRef
28.
go back to reference Kuppersmith RB, Holsinger FC (2011) Robotic thyroid surgery: an initial experience with North American patients. Laryngoscope 121(3):521–526PubMedCrossRef Kuppersmith RB, Holsinger FC (2011) Robotic thyroid surgery: an initial experience with North American patients. Laryngoscope 121(3):521–526PubMedCrossRef
29.
go back to reference Landry CS, Grubbs EG, Morris GS, Turner NS, Holsinger FC, Lee JE, Perrier ND (2011) Robot assisted transaxillary surgery (RATS) for the removal of thyroid and parathyroid glands. Surgery 149(4):549–555PubMedCrossRef Landry CS, Grubbs EG, Morris GS, Turner NS, Holsinger FC, Lee JE, Perrier ND (2011) Robot assisted transaxillary surgery (RATS) for the removal of thyroid and parathyroid glands. Surgery 149(4):549–555PubMedCrossRef
Metadata
Title
A comparative study of the surgical outcomes of robotic and conventional open modified radical neck dissection for papillary thyroid carcinoma with lateral neck node metastasis
Authors
Sang-Wook Kang
So Hee Lee
Jae Hyun Park
Jun Soo Jeong
Seulkee Park
Cho Rok Lee
Jong Ju Jeong
Kee-Hyun Nam
Woong Youn Chung
Cheong Soo Park
Publication date
01-11-2012
Publisher
Springer-Verlag
Published in
Surgical Endoscopy / Issue 11/2012
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-012-2333-1

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