Gasless Transaxillary Endoscopic Thyroidectomy with Robotic Assistance: A High-Volume Experience in North America
Gasless Transaxillary Endoscopic Thyroidectomy with Robotic Assistance: A High-Volume Experience in North America
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DOI：
10.1089/thy.2018.0404
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发表时间：
2018-10-16
期刊：
影响因子：
6.6
通讯作者：
Carty, Sally E.
中科院分区：
文献类型：
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作者：
Stang, Michael T.;Yip, Linwah;Carty, Sally E.
背景资料：自9年前引入以来，机器人辅助（RT）的无气体经腋下甲状腺切除术在北美的应用相对有限。本研究旨在评估近期在一个大的，多样化的北美population.Methods：选择RT方法从2010年11月至2015年7月的患者的偏好，他们的围手术期数据进行回顾性reviewed.Results：在301机器人甲状腺切除术完成的281例患者，160例是甲状腺全切除术和141叶切除术。女性占大多数（98.9%），平均年龄41岁（范围17-74岁），平均随访24个月（范围3-71个月）。平均体重指数（BMI）为25.7 kg/m2（范围17-44 kg/m2）。然而，33.3%的患者BMI为25-29.9 kg/m2，12.4%的患者BMI为30-34.9 kg/m2，3.5%的患者BMI为35-39.9 kg/m2，0.7%的患者BMI >= 40 kg/m2。除20例完成肺叶切除术外，手术适应症为不确定细胞学（53%）、恶性细胞学（10%）、生长（18%）、格雷夫斯病（12%）和其他（5%）。最大切除结节的平均大小为2.5 cm（范围0.7-6.4 cm）。机器人肺叶切除术和甲状腺全切除术的平均手术时间分别为81和109分钟。1例患者因内镜检查进展失败而转为标准颈部切开术。并发症包括暂时性发音困难（6.0%）、永久性喉返神经缺损（1.3%）、低钙血症（暂时性8.2%，永久性1.1%）、血清肿（0.7%）和需要再次手术的血肿（0.3%）。BMI ≥ 25 kg/m2的患者与BMI> 3 cm或因Graves甲状腺炎接受手术的患者的并发症无差异。1例患者在2年时发生腋切口同侧II级手臂水肿，经保守治疗后消退。无患者发生手术部位感染或臂丛神经病变。133例（48%）患者的组织学上存在癌症。在91例索引结节癌患者中，48.4%为乳头状癌，44.0%为滤泡变异乳头状癌，2.2%为微创滤泡癌，5.5%为微创Hurthle细胞癌。1例为硬化性变异型甲状腺副神经节瘤。到目前为止，所有患者都没有肿瘤复发的证据。结论：在一个高容量的中心，无气体经腋下腔镜甲状腺手术与机器人辅助是一种安全，高效，有效的方法，在不同的北美患者群体。
Background: Since its introduction nine years ago, gasless transaxillary thyroidectomy with robotic assistance (RT) has achieved a relatively limited application in North America. This study aimed to assess the outcomes of RT in a recent large, diverse North American population.Methods: Consenting patients were selected for the RT approach from November 2010 to July 2015 based on patient preference, and their perioperative data were retrospectively reviewed.Results: Of 301 robotic thyroidectomies completed in 281 patients, 160 were total thyroidectomy and 141 were lobectomy. Women predominated (98.9%), with a mean age of 41 years (range 17-74 years) and a mean follow-up of 24 months (range 3-71 months). The mean body mass index (BMI) was 25.7 kg/m(2) (range 17-44 kg/m(2)). However, 33.3% of patients had a BMI 25-29.9 kg/m(2), 12.4% had a BMI 30-34.9 kg/m(2), 3.5% had a BMI 35-39.9 kg/m(2), and 0.7% had a BMI >= 40 kg/m(2). Excluding 20 completion lobectomy, the indications for surgery were indeterminate cytology (53%), malignant cytology (10%), growth (18%), Graves' disease (12%), and other (5%). The mean size of the largest resected nodule was 2.5 cm (range 0.7-6.4 cm). Mean operating time for robotic lobectomy and total thyroidectomy was 81 and 109 minutes, respectively. One patient was converted to standard cervicotomy for failure to progress endoscopically. Complications included temporary dysphonia (6.0%), permanent recurrent laryngeal nerve deficit (1.3%), hypocalcemia (temporary 8.2%, permanent 1.1%), seroma (0.7%), and hematoma requiring reoperation (0.3%). Complications did not differ in patients with a BMI >= 25 kg/m(2) compared to those with a BMI 3 cm or surgery for Graves' thyroiditis. One patient developed grade II arm lymphedema ipsilateral to the axillary incision at two years, which resolved with conservative management. No patient had a surgical site infection or brachial plexopathy. Cancer was present histologically in 133 (48%) patients. Among 91 patients with cancer of the index nodule, 48.4% had papillary, 44.0% follicular variant papillary, 2.2% minimally invasive follicular carcinoma, and 5.5% minimally invasive Hurthle cell carcinoma. One patient had sclerosing variant thyroid paraganglioma. To date, all patients are without evidence of tumor recurrence.Conclusions: At a high-volume center, gasless transaxillary endoscopic thyroid surgery done with robotic assistance is a safe, efficient, and effective approach in a diverse North American patient population.