M. E. Garstka1, K. Moshin1, D. Bu Ali1, H. Shalaby1, K. Ibraheem1, M. Abdulgawad Farag1, L. Saparova1, S. Kang1, E. Kandil1 1Tulane University School Of Medicine,Department Of Surgery,New Orleans, LA, USA
Introduction:
Many recent studies report the safety and feasibility of robotic-assisted thyroid surgery, but most of these studies were performed in Asia. In the United States, several small series and case reports have been published regarding treatment of benign disease. The aim of our study is to report the safety and feasibility of robot-assisted thyroid surgery for well-differentiated thyroid cancer patients at a Western institution.
Methods:
We performed a retrospective cohort study using a prospectively collected single-center clinical database at an academic medical center. We included all well-differentiated thyroid cancer patients who underwent robotic–assisted or conventional cervical approach thyroid surgery at our institution from January 2015 to June 2017. Patient demographics and perioperative data were collected and analyzed. The primary outcomes evaluated in this initial analysis included operating times, estimated blood loss, hospital length of stay, and complications. Patient demographics included sex, race, and BMI. Pathology characteristics including specimen size, microscopic margin status, and number of lymph nodes removed were also analyzed, as was duration of patient follow-up and episodes of clinical recurrence of disease.
Results:
A total of 144 surgeries for thyroid cancer were performed; 35 (24.3%) were performed with robotic-assisted technique. The majority of patients in the sample were female (113 patients, 78.5%) and Caucasian (81, 59.1%). Mean age of the patients undergoing robotic-assisted surgery was 42.1±12.5 years, which was significantly less than those undergoing the conventional cervical approach at 52.7±15.6 years (p = 0.003), and mean BMI of 25.0±4.3 kg/m2 for robotic-assisted patients was significantly less than that for cervical approach, at 32.5±8.1kg/m2 (p = <0.0001). There were no significant differences in estimated blood loss, operative times, complication rates, specimen sizes, positive microscopic margins, number of lymph nodes removed with associated lymph node dissections, patient follow-up duration, or clinical recurrence rates between the two groups. However, overall length of stay was shorter for robotic-assisted surgical patients, at 0.6±0.9 days, versus 1.1±1.2 days for conventional cervical approach surgical patients (p=0.0087). Of note, for robotic-assisted surgical patients, 54.3% were discharged on the day of surgery (19 patients), and only one patient was admitted as inpatient to the hospital for greater than 23 hours (2.9%).
Conclusion:
Robot-assisted thyroid surgery is a safe and feasible approach for a select group of well-differentiated thyroid cancer patients with regards to the short-term outcomes analyzed in this study. Future multi-institutional studies and long-term oncologic follow-up studies are needed to further evaluate the outcomes of this technique.