Gasless transaxillary robotic thyroidectomy
Epublication WebSurg.com, Apr 2012;12(04). URL: http://websurg.com/doi/lt03enchung001
Robotic technology has recently been applied to minimally invasive thyroid surgery, with the Da Vinci Surgical System robot (Intuitive Surgical, Inc., Sunnyvale, CA, USA). This system provides a three-dimensional magnified view of the surgical area, hand-tremor filtration, fine-motion scaling, and precise and multiarticulated hand-like motions. Several different approaches have been developed with respect to the location of the incisions and whether or not CO2 insufflation is required to keep the operative space open. Robotic gasless transaxillary thyroidectomy has been used clinically in Korea since late 2007. It has been validated for surgical management of the thyroid gland. The initial cases of robotic thyroidectomy was limited to the well-differentiated thyroid carcinoma with a tumor size of ≤ 2cm without definite extrathyroidal tumor invasion (T1 lesion) or follicular neoplasm with a tumor size of ≤5cm. As robotic experience accumulated, the indication of robotic thyroidectomy to include those patients with T3 or larger size lesions has been expanded. The initial robotic thyroidectomy resembled the endoscopic thyroidectomy using two separate incisions, axilla and anterior chest wall. With sufficient experience, the anterior chest wall incision was removed and developed a less invasive transaxillary single-incision robotic thyroidectomy. This procedure has reduced the dissection and the surgical invasiveness with similar surgical outcomes. Until now, more than 100 cases of compartment-oriented modified radical neck dissection with acceptable postoperative outcomes and excellent cosmesis had been also performed with the Da Vinci robotic system.