The application of robot-assisted super-meticulous capsular dissection in thyroid cancer surgery: a report of 1 045 cases
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Department of Breast and Thyroid Surgery, the First Affiliated Hospital of the Army Military Medical University, Chongqing 400038, China

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R736.1

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    Abstract:

    Background and Aims Due to the 3D visualization and flexible intra-articular elements of robotic surgical devices, the application of robotic surgical systems in thyroid surgery has expanded the scope of laparoscopic surgery. This study was designed to provide a summary and analysis of patients with thyroid cancer (TC) undergoing robot-assisted radical thyroidectomy with super-meticulous capsular dissection (SMCD) technique in the authors' hospital, to evaluate the efficacy and safety of implementing the SMCD technique with robotic assistance.Methods The clinical data of 1 045 TC patients who underwent robotic-assisted radical thyroidectomy with SMCD technique in the First Affiliated Hospital of the Army Military Medical University from June 2018 to May 2022 were retrospectively analyzed.Results All 1 045 patients successfully underwent robotic surgery. Among them, 214 cases (20.5%) underwent unilateral lobectomy with unilateral central lymph node dissection, 342 cases (32.7%) underwent total thyroidectomy with unilateral central lymph node dissection, 317 cases (30.3%) underwent total thyroidectomy with bilateral central lymph node dissection, 157 cases (15.0%) underwent unilateral lateral neck dissection and 15 cases (1.4%) underwent bilateral lateral neck dissection. Except for 172 cases (16.5%) who underwent lateral neck dissection via the bilateral axillo-breast approach (BABA), the remaining 873 cases (83.5%) were completed via the unilateral axilla-bilateral areola approach (UABA), with an average operative time of (151.74±59.62) min. Parathyroid transplantation was performed in 38 cases (3.6%), and 336 cases (32.2%) underwent postoperative 131I treatment. After operation, temporary hypoparathyroidism occurred in 245 cases (23.4%), and permanent hypoparathyroidism occurred in 7 cases (0.7%); temporary hoarseness occurred in 4 cases (0.4%); local recurrence occurred in 3 cases (0.3%). Both univariate and multivariate analyses showed that the extent of surgery was a factor for the occurrence of temporary hypoparathyroidism (HR=1.51, 95% CI=0.90-2.49, P<0.001; HR=1.20, 95% CI=1.00-1.43, P=0.049).Conclusion Robotic surgery for TC is safe and thorough, and the UABA approach is capable of performing robotic total thyroidectomy plus central compartment clearance, while the BABA approach is a more suitable choice for lateral lymph node dissection. The application of SMCD with robotic assistance helps preserve parathyroid function and reduces the occurrence of permanent hypoparathyroidism.

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QIN Xiangquan, ZHAO Jingjing, LUO Jia, ZENG Lingjuan, FAN Linjun. The application of robot-assisted super-meticulous capsular dissection in thyroid cancer surgery: a report of 1 045 cases[J]. Chin J Gen Surg,2023,32(11):1677-1686.
DOI:10.7659/j. issn.1005-6947.2023.11.006

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History
  • Received:August 09,2023
  • Revised:November 03,2023
  • Adopted:
  • Online: December 15,2023
  • Published: