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Published in: Surgical Endoscopy 7/2012

01-07-2012

Functional voice and swallowing outcomes after robotic thyroidectomy by a gasless unilateral axillo-breast approach: comparison with open thyroidectomy

Authors: Kyung Tae, Ki Yong Kim, Bo Ram Yun, Yong Bae Ji, Chul Won Park, Dong Sun Kim, Tae Wha Kim

Published in: Surgical Endoscopy | Issue 7/2012

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Abstract

Background

Voice and swallowing alterations are common complaints after thyroidectomy, even in the absence of laryngeal nerve impairment. However, voice and swallowing functions after robotic thyroidectomy have not been thoroughly investigated. This study compared the functional outcomes for voice and swallowing after robotic thyroidectomy and conventional open thyroidectomy.

Methods

The study prospectively analyzed the voice and swallowing functions of patients with thyroid nodules who underwent robotic thyroidectomy by a gasless unilateral axillo-breast (GUAB) approach (50 cases) or by conventional open thyroidectomy (61 cases) from September 2009 to October 2010. Videolaryngostroboscopy or flexible laryngoscopy was performed pre- and postoperatively. Subjective voice and swallowing alterations were assessed by questionnaire preoperatively and then 1 day, 1 week, 1 month, 3 months, and 6 months postoperatively. In addition, objective acoustic voice analysis was performed using a Multidimensional Voice Program, with Voice Range Profiles and maximum phonation times measured preoperatively and then 1 week, 1 month, 3 months, and 6 months postoperatively.

Results

Subjective postoperative voice function was significantly better in the robotic group at 1 day, 1 month, and 3 months postoperatively than in the open group. The mean values of fundamental frequency, jitter, shimmer and noise-to-harmonic ratio before and after surgery did not differ between the two groups. However, the frequency range and the highest frequency were significantly better in the robotic group than in the open group at 3 months postoperatively. Subjective swallowing function did not differ between the two groups.

Conclusion

Postoperative voice function is better with robotic thyroidectomy using the GUAB approach than with conventional open thyroidectomy. This is an advantage of robotic thyroidectomy by the GUAB approach in addition to the excellent cosmesis.
Literature
1.
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 146:1048–1055PubMedCrossRef 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 146:1048–1055PubMedCrossRef
2.
go back to reference Lee KE, Koo do H, Kim SJ, Lee J, Park KS, Oh SK, Youn YK (2010) Outcomes of 109 patients with papillary thyroid carcinoma who underwent robotic total thyroidectomy with central node dissection via the bilateral axillo-breast approach. Surgery 148:1207–1213PubMedCrossRef Lee KE, Koo do H, Kim SJ, Lee J, Park KS, Oh SK, Youn YK (2010) Outcomes of 109 patients with papillary thyroid carcinoma who underwent robotic total thyroidectomy with central node dissection via the bilateral axillo-breast approach. Surgery 148:1207–1213PubMedCrossRef
3.
go back to reference Tae K, Ji YB, Jeong JH, Lee SH, Jeong MA, Park CW (2011) Robotic thyroidectomy by a gasless unilateral axillo-breast or axillary approach: our early experiences. Surg Endosc 25:221–228PubMedCrossRef Tae K, Ji YB, Jeong JH, Lee SH, Jeong MA, Park CW (2011) Robotic thyroidectomy by a gasless unilateral axillo-breast or axillary approach: our early experiences. Surg Endosc 25:221–228PubMedCrossRef
4.
go back to reference Kuppersmith RB, Holsinger FC (2011) Robotic thyroid surgery: an initial experience with North American patients. Laryngoscope 121:521–526PubMedCrossRef Kuppersmith RB, Holsinger FC (2011) Robotic thyroid surgery: an initial experience with North American patients. Laryngoscope 121:521–526PubMedCrossRef
5.
go back to reference Tae K, Ji YB, Cho SH, Lee SH, Kim DS, Kim TW (2011). Early surgical outcomes of robotic thyroidectomy by a gasless unilateral axillo-breast or axillary approach for papillary thyroid carcinoma: two years’ experience. Head Neck. doi:10.1002/hed.21782 Tae K, Ji YB, Cho SH, Lee SH, Kim DS, Kim TW (2011). Early surgical outcomes of robotic thyroidectomy by a gasless unilateral axillo-breast or axillary approach for papillary thyroid carcinoma: two years’ experience. Head Neck. doi:10.​1002/​hed.​21782
6.
go back to reference Terris DJ, Singer MC, Seybt MW (2011) Robotic facelift thyroidectomy: II. Clinical feasibility and safety. Laryngoscope 121:1636–1641PubMedCrossRef Terris DJ, Singer MC, Seybt MW (2011) Robotic facelift thyroidectomy: II. Clinical feasibility and safety. Laryngoscope 121:1636–1641PubMedCrossRef
7.
go back to reference Ikeda Y, Takami H, Niimi M, Kan S, Sasaki Y, Takayama J (2001) Endoscopic thyroidectomy by the axillary approach. Surg Endosc 15:1362–1364PubMedCrossRef Ikeda Y, Takami H, Niimi M, Kan S, Sasaki Y, Takayama J (2001) Endoscopic thyroidectomy by the axillary approach. Surg Endosc 15:1362–1364PubMedCrossRef
8.
go back to reference Shimazu K, Shiba E, Tamaki Y, Takiguchi S, Taniguchi E, Ohashi S, Noguchi S (2003) Endoscopic thyroid surgery through the axillo-bilateral breast approach. Surg Laparosc Endosc 13:196–201CrossRef Shimazu K, Shiba E, Tamaki Y, Takiguchi S, Taniguchi E, Ohashi S, Noguchi S (2003) Endoscopic thyroid surgery through the axillo-bilateral breast approach. Surg Laparosc Endosc 13:196–201CrossRef
9.
go back to reference Choe JH, Kim SW, Chung KW, Park KS, Han W, Noh DY, Oh SK, Youn YK (2007) Endoscopic thyroidectomy using a new bilateral axillo-breast approach. World J Surg 31:601–606PubMedCrossRef Choe JH, Kim SW, Chung KW, Park KS, Han W, Noh DY, Oh SK, Youn YK (2007) Endoscopic thyroidectomy using a new bilateral axillo-breast approach. World J Surg 31:601–606PubMedCrossRef
10.
go back to reference Tae K, Kim SY, Lee YS, Lee HS (2007) Gasless endoscopic thyroidectomy by an axillary approach: preliminary report. Korean J Otolaryngol 50:252–256 Tae K, Kim SY, Lee YS, Lee HS (2007) Gasless endoscopic thyroidectomy by an axillary approach: preliminary report. Korean J Otolaryngol 50:252–256
11.
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 transaxillary approach: surgical outcomes of 581 patients. Endocr J 56:361–369PubMedCrossRef 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 transaxillary approach: surgical outcomes of 581 patients. Endocr J 56:361–369PubMedCrossRef
12.
go back to reference Koh YW, Kim JW, Lee SW, Choi EC (2009) Endoscopic thyroidectomy via a unilateral axillo-breast approach without gas insufflation for unilateral benign thyroid lesions. Surg Endosc 23:2053–2060PubMedCrossRef Koh YW, Kim JW, Lee SW, Choi EC (2009) Endoscopic thyroidectomy via a unilateral axillo-breast approach without gas insufflation for unilateral benign thyroid lesions. Surg Endosc 23:2053–2060PubMedCrossRef
13.
go back to reference Tae K, Ji YB, Cho SH, Kim KR, Kim DW, Kim DS (2011) Initial experience with a gasless unilateral axillo-breast or axillary approach endoscopic thyroidectomy for papillary thyroid microcarcinoma: comparison with conventional open thyroidectomy. Surg Laparosc Endosc Percutan Tech 21:162–169PubMedCrossRef Tae K, Ji YB, Cho SH, Kim KR, Kim DW, Kim DS (2011) Initial experience with a gasless unilateral axillo-breast or axillary approach endoscopic thyroidectomy for papillary thyroid microcarcinoma: comparison with conventional open thyroidectomy. Surg Laparosc Endosc Percutan Tech 21:162–169PubMedCrossRef
14.
go back to reference Perrier ND, Randolph GW, Inabnet WB, Marple BF, VanHeerden J, Kuppersmith RB (2010) Robotic thyroidectomy: a framework for new technology assessment and safe implementation. Thyroid 20:1327–1332PubMedCrossRef Perrier ND, Randolph GW, Inabnet WB, Marple BF, VanHeerden J, Kuppersmith RB (2010) Robotic thyroidectomy: a framework for new technology assessment and safe implementation. Thyroid 20:1327–1332PubMedCrossRef
15.
go back to reference Ikeda Y, Takami H, Sasaki Y, Takayama J, Niimi M, Kan S (2003) Clinical benefits in endoscopic thyroidectomy by the axillary approach. J Am Coll Surg 196:189–195PubMedCrossRef Ikeda Y, Takami H, Sasaki Y, Takayama J, Niimi M, Kan S (2003) Clinical benefits in endoscopic thyroidectomy by the axillary approach. J Am Coll Surg 196:189–195PubMedCrossRef
16.
go back to reference Miccoli P, Rago R, Massi M, Panicucci E, Metelli MR, Berti P, Minuto MN (2010) Standard versus video-assisted thyroidectomy: objective postoperative pain evaluation. Surg Endosc 24:2415–2417PubMedCrossRef Miccoli P, Rago R, Massi M, Panicucci E, Metelli MR, Berti P, Minuto MN (2010) Standard versus video-assisted thyroidectomy: objective postoperative pain evaluation. Surg Endosc 24:2415–2417PubMedCrossRef
17.
go back to reference Del Rio P, Berti M, Sommaruga L, Arcuri MF, Cataldo S, Sianesi M (2008) Pain after minimally invasive videoassisted and after minimally invasive open thyroidectomy: results of a prospective outcome study. Langenbecks Arch Surg 393:271–273PubMedCrossRef Del Rio P, Berti M, Sommaruga L, Arcuri MF, Cataldo S, Sianesi M (2008) Pain after minimally invasive videoassisted and after minimally invasive open thyroidectomy: results of a prospective outcome study. Langenbecks Arch Surg 393:271–273PubMedCrossRef
18.
go back to reference Lombardi CP, Raffaelli M, D’alatri L, De Crea C, Marchese MR, Maccora D, Paludetti G, Bellantone R (2008) Video-assisted thyroidectomy significantly reduces the risk of early postthyroidectomy voice and swallowing symptoms. World J Surg 32:693–700PubMedCrossRef Lombardi CP, Raffaelli M, D’alatri L, De Crea C, Marchese MR, Maccora D, Paludetti G, Bellantone R (2008) Video-assisted thyroidectomy significantly reduces the risk of early postthyroidectomy voice and swallowing symptoms. World J Surg 32:693–700PubMedCrossRef
19.
go back to reference Lee J, Nah KY, Kim RM, Ahn YH, Soh EY, Chung WY (2010) Differences in postoperative outcomes, function, and cosmesis: open versus robotic thyroidectomy. Surg Endosc 24:3186–3194PubMedCrossRef Lee J, Nah KY, Kim RM, Ahn YH, Soh EY, Chung WY (2010) Differences in postoperative outcomes, function, and cosmesis: open versus robotic thyroidectomy. Surg Endosc 24:3186–3194PubMedCrossRef
20.
go back to reference Hong KH, Kim YK (1997) Phonatory characteristics of patients undergoing thyroidectomy without laryngeal nerve injury. Otolaryngol Head Neck Surg 117:399–404PubMedCrossRef Hong KH, Kim YK (1997) Phonatory characteristics of patients undergoing thyroidectomy without laryngeal nerve injury. Otolaryngol Head Neck Surg 117:399–404PubMedCrossRef
21.
go back to reference Stojadinovic A, Shaha AR, Orlikoff RF, Nissan A, Kornak MF, Singh B, Boyle JO, Shah JP, Brennan MF, Kraus DH (2002) Prospective functional voice assessment in patients undergoing thyroid surgery. Ann Surg 236:823–832PubMedCrossRef Stojadinovic A, Shaha AR, Orlikoff RF, Nissan A, Kornak MF, Singh B, Boyle JO, Shah JP, Brennan MF, Kraus DH (2002) Prospective functional voice assessment in patients undergoing thyroid surgery. Ann Surg 236:823–832PubMedCrossRef
22.
go back to reference Debruyne F, Ostyn F, Delaere P, Wellens W (1997) Acoustic analysis of the speaking voice after thyroidectomy. J Voice 11:479–482PubMedCrossRef Debruyne F, Ostyn F, Delaere P, Wellens W (1997) Acoustic analysis of the speaking voice after thyroidectomy. J Voice 11:479–482PubMedCrossRef
23.
go back to reference Pereira JA, Girvent M, Sancho JJ, Parada C, Sitges-Serra A (2003) Prevalence of long-term upper aerodigestive symptoms after uncomplicated bilateral thyroidectomy. Surgery 133:318–322PubMedCrossRef Pereira JA, Girvent M, Sancho JJ, Parada C, Sitges-Serra A (2003) Prevalence of long-term upper aerodigestive symptoms after uncomplicated bilateral thyroidectomy. Surgery 133:318–322PubMedCrossRef
24.
go back to reference Sinagra DL, Montesinos MR, Tacchi VA, Moreno JC, Falco JE, Mezzadri NA, Debonis DL, Curutchet HP (2004) Voice changes after thyroidectomy without recurrent laryngeal nerve injury. J Am Coll Surg 199:556–560PubMedCrossRef Sinagra DL, Montesinos MR, Tacchi VA, Moreno JC, Falco JE, Mezzadri NA, Debonis DL, Curutchet HP (2004) Voice changes after thyroidectomy without recurrent laryngeal nerve injury. J Am Coll Surg 199:556–560PubMedCrossRef
25.
go back to reference de Pedro Netto I, Fae A, Vartanian JG, Barros AP, Correia LM, Toledo RN, Testa JR, Nishimoto IN, Kowalski LP, Carrara-de Angelis E (2006) Voice and vocal self-assessment after thyroidectomy. Head Neck 28:1106–1114PubMedCrossRef de Pedro Netto I, Fae A, Vartanian JG, Barros AP, Correia LM, Toledo RN, Testa JR, Nishimoto IN, Kowalski LP, Carrara-de Angelis E (2006) Voice and vocal self-assessment after thyroidectomy. Head Neck 28:1106–1114PubMedCrossRef
26.
go back to reference Musholt TJ, Musholt PB, Garm J, Napiontek U, Keilmann A (2006) Changes of the speaking and singing voice after thyroid or parathyroid surgery. Surgery 140:978–988PubMedCrossRef Musholt TJ, Musholt PB, Garm J, Napiontek U, Keilmann A (2006) Changes of the speaking and singing voice after thyroid or parathyroid surgery. Surgery 140:978–988PubMedCrossRef
27.
go back to reference Lombardi CP, Raffaelli M, D’Alatri L, Marchese MR, Rigante M, Paludetti G, Bellantone R (2006) Voice and swallowing changes after thyroidectomy in patients without inferior laryngeal nerve injuries. Surgery 140:1026–1032PubMedCrossRef Lombardi CP, Raffaelli M, D’Alatri L, Marchese MR, Rigante M, Paludetti G, Bellantone R (2006) Voice and swallowing changes after thyroidectomy in patients without inferior laryngeal nerve injuries. Surgery 140:1026–1032PubMedCrossRef
28.
go back to reference Lombardi CP, Raffaelli M, De Crea C, D’Alatri L, Maccora D, Marchese MR, Paludetti G, Bellantone R (2009) Long-term outcome of functional post-thyroidectomy voice and swallowing symptoms. Surgery 146:1174–1181PubMedCrossRef Lombardi CP, Raffaelli M, De Crea C, D’Alatri L, Maccora D, Marchese MR, Paludetti G, Bellantone R (2009) Long-term outcome of functional post-thyroidectomy voice and swallowing symptoms. Surgery 146:1174–1181PubMedCrossRef
29.
go back to reference Henry LR, Solomon NP, Howard R, Gurevich-Uvena J, Horst LB, Coppit G, Orlikoff R, Libutti SK, Shaha AR, Stojadinovic A (2008) The functional impact on voice of sternothyroid muscle division during thyroidectomy. Ann Surg Oncol 15:2027–2033PubMedCrossRef Henry LR, Solomon NP, Howard R, Gurevich-Uvena J, Horst LB, Coppit G, Orlikoff R, Libutti SK, Shaha AR, Stojadinovic A (2008) The functional impact on voice of sternothyroid muscle division during thyroidectomy. Ann Surg Oncol 15:2027–2033PubMedCrossRef
30.
go back to reference Van Lierde K, D’haeseleer E, Wuyts FL, Baudonck N, Bernaert L, Vermeersch H (2010) Impact of thyroidectomy without laryngeal nerve injury on vocal quality characteristics: an objective multiparameter approach. Laryngoscope 120:338–345PubMed Van Lierde K, D’haeseleer E, Wuyts FL, Baudonck N, Bernaert L, Vermeersch H (2010) Impact of thyroidectomy without laryngeal nerve injury on vocal quality characteristics: an objective multiparameter approach. Laryngoscope 120:338–345PubMed
31.
go back to reference Robinson JL, Mandel S, Sataloff RT (2004) Objective voice measures in nonsinging patients with unilateral superior laryngeal nerve paresis. J Voice 19:665–667CrossRef Robinson JL, Mandel S, Sataloff RT (2004) Objective voice measures in nonsinging patients with unilateral superior laryngeal nerve paresis. J Voice 19:665–667CrossRef
32.
go back to reference Dursun G, Sataloff RT, Spiegel JR, Mandel S, Heuer RJ, Risen DC (1996) Superior laryngeal nerve paresis and paralysis. J Voice 10:206–211PubMedCrossRef Dursun G, Sataloff RT, Spiegel JR, Mandel S, Heuer RJ, Risen DC (1996) Superior laryngeal nerve paresis and paralysis. J Voice 10:206–211PubMedCrossRef
33.
go back to reference Hong KH, Ye M, Kim YM, Kevorkian KF, Berke GS (1997) The role of strap muscles in phonation: in vivo canine laryngeal model. J Voice 11:23–32PubMedCrossRef Hong KH, Ye M, Kim YM, Kevorkian KF, Berke GS (1997) The role of strap muscles in phonation: in vivo canine laryngeal model. J Voice 11:23–32PubMedCrossRef
Metadata
Title
Functional voice and swallowing outcomes after robotic thyroidectomy by a gasless unilateral axillo-breast approach: comparison with open thyroidectomy
Authors
Kyung Tae
Ki Yong Kim
Bo Ram Yun
Yong Bae Ji
Chul Won Park
Dong Sun Kim
Tae Wha Kim
Publication date
01-07-2012
Publisher
Springer-Verlag
Published in
Surgical Endoscopy / Issue 7/2012
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-011-2116-0

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