Comparison of surgical outcomes between endoscopic and robotic thyroidectomy
Comparison of surgical outcomes between endoscopic and robotic thyroidectomy
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DOI：
10.1002/jso.22106
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发表时间：
2012-06-01
影响因子：
2.5
通讯作者：
Bae, Ja Seong
中科院分区：
文献类型：
--
作者：
Yoo, Ho;Chae, Byung Joo;Bae, Ja Seong
目的非气腹腋窝内窥镜甲状腺切除术与传统的开放手术相比具有明显的优势，因为它不会留下明显的颈部疤痕。随着新的外科技术和器械的发展，适应症已经扩大。然而，由于该手术的二维切面和不灵活的器械，该手术不容易适用于全甲状腺切除术。因此，机器人手术已经被引入，并提供了更好的可视化和灵活性。但是，目前还不清楚机器人甲状腺切除术是否比内窥镜甲状腺切除术有任何潜在的好处。本研究的目的是通过对手术结果的比较，确定机器人手术是否优于内窥镜手术。方法：自2009年5月至2011年2月，165例患者接受了内窥镜甲状腺切除术(内镜组)，46例患者接受了机器人甲状腺切除术(机器人组)。两组均采用非气腹腋窝入路。结果：两组患者在患者特征、平均中心淋巴结清扫数、病理特征、住院时间、术后并发症发生率、血清甘油三酯水平等方面相似。然而，甲状腺切除术的平均总手术时间内窥镜组为126.2±37.84min，机器人组为179.6±44.34min(P<；0.001)。术后肺叶切除术总引流量内窥镜组为153.3±45.64，机器人组为179.9±49.15(P=0.031)。当缺乏两种手术技术优势的证据时，成本效益也是一个重要的考虑因素。机器人甲状腺切除术的平均成本为6,655美元，而内窥镜甲状腺切除术的平均成本为829美元(P<；0.001)。两组术后低钙血症、喉返神经损伤、乳糜漏、气管损伤等并发症发生率差异无统计学意义(P=0.332)。结论：机器人甲状腺切除术手术时间长、费用高，术后引流量增加，肿瘤预后和并发症发生率无明显改善。因此，我们的数据不支持机器人手术比内窥镜手术有任何优势。J·奥科尔外科医生。2012年；105：705-708。(C)2011年威利期刊公司。
Objectives Gasless transaxillary endoscopic thyroidectomy offers a distinct advantage over the conventional open operation because it leaves no visible neck scar. Indications have expanded with the development of new surgical techniques and instruments. However, because of the two-dimensional view and the nonflexible instruments, this procedure is not easily amenable for total thyroidectomy. So, robotic surgery has been introduced and offers improved visualization and dexterity. But, it remains unclear whether robotic thyroidectomy offers any potential benefits over endoscopic thyroidectomy. The aim of this present study was to determine whether robotic surgery is superior to endoscopic surgery through a comparison of surgical outcomes.Methods: Between May 2009 and February 2011, 165 patients underwent endoscopic thyroidectomy (endoscopy group) and 46 patients underwent robotic thyroidectomy (robot group). A gasless transaxillary approach was used in both groups. The two groups were compared in terms of patient characteristics, perioperative clinical results, pathologic findings, and postoperative complication.Results: Both patient groups were similar in terms of patient characteristics, mean number of retrieved central lymph nodes, pathological features, length of hospital stays, postoperative complication rate, and serum Tg level. However, the mean total operation time for thyroidectomy was 126.2 +/- 37.84 min in the endoscopy group and 179.6 +/- 44.34 min in the robot group (P < 0.001). Postoperative total drainage for lobectomy was 153.3 +/- 45.64 for the endoscopy group and 179.9 +/- 49.15 for the robot group (P = 0.031). Cost effectiveness is also an important consideration when evidence for predominance of two surgical techniques is lacking. The mean cost of robotic thyroidectomy was $6,655, compared with $829 for endoscopic thyroidectomy (P < 0.001). There was no significant difference in postoperative complications as hypocalcemia, recurrent laryngeal nerve injury, chyle leakage and tracheal injury in the two groups (P = 0.332).Conclusion: Robotic thyroidectomy was lengthier in duration than endoscopic thyroidectomy, more costly, and associated with increased postoperative drainage with no improvement in oncologic outcomes or complication rates. Therefore our data do not support any advantage of robotic surgery over endoscopic surgery. J. Surg. Oncol. 2012; 105: 705-708. (C) 2011 Wiley Periodicals, Inc.