경부-액와접근법을 이용한 내시경 갑상선절제술과 로봇하 갑상선절제술의 비교 및 고찰

박영민,임우성,문병인 대한갑상선-내분비외과학회 2012 The Koreran journal of Endocrine Surgery Vol.12 No.4

Purpose: Endoscopic and robot-assisted thyroidectomy has shown rapid development worldwide. In addition, there is no treatment of choice for thyroidectomy as usual. We propose an endoscopic thyroidectomy using a cervico-transaxillary approach, comparing its results with those of robot-assisted thyroidectomy. We present this study in order to provide advantages and disadvantages. Methods: Between January 2010 and March 2012, 132 patients were recruited with clinicopathological data for this study. We divided patients into two groups, the endoscopic and the robot groups, with respect to their clinical characteristics, surgical outcomes. The outcomes were evaluated in terms of operation time, estimated blood loss, hemovac amount, hospital stay, and number of lymph nodes harvested. Results: A total of 132 patients (male 6 and female 126) were recruited with clinicopathological data for this study. Of these, 78 patients underwent endoscopic thyroidectomy (the endo group) and 54 underwent robot-assisted thyroidectomy (the robot group) using a cervico-transaxillary approach. The two groups did not differ significantly in terms of age, estimated blood loss, and complications. None of the patients experienced severe complications. Conclusion: Results of the preliminary comparison in this study show that both approaches are safe and feasible, with similar results. However, a smaller hemovac amount was observed with endoscopic thyroidectomy, compared to robot-assisted thyroidectomy. In order to cut costs, part of robot-assisted thyroidectomy could be replaced by endoscopic thyroidectomy.

갑상선암에 대한 로봇 보조 내시경적 갑상선 절제술; 100예에 대한 초기 경험

강상욱 ( Sang-wook Kang ),정종주 ( Jong Ju Jeong ),윤지섭 ( Ji-sup Yun ),성태연 ( Tae Yon Sung ),이승철 ( Seung Chul Lee ),이용상 ( Yong Sang Lee ),남기현 ( Kee-hyun Nam ),장항석 ( Hang Seok Chang ),정웅윤 ( Woong Youn Chung ) 대한갑상선학회 2008 International Journal of Thyroidology Vol.1 No.2

Background and Objectives: Various surgical procedures have been performed using surgical robot in recent years and most reports proved that application of robotic technology for surgery is technically feasible and safe. The aim of this study is to introduce our technique of robot-assisted endoscopic thyroid surgery and demonstrate its utility in the surgical management of thyroid cancer. Materials and Methods: From October 4^th 2007 through March 14^th 2008, 100 patients with papillary thyroid cancer underwent robot-assisted endoscopic surgeries using a gasless trans-axillary approach. This novel robotic surgical approach allowed adequate endoscopic access for thyroid surgeries. All the procedures were completed successfully using the da Vinci surgical system (Intuitive Surgical, Sunnyvale, California, USA). We used four robotic arms with this system; a 12 mm telescope and three 5 mm instruments. The 3-dimensional magnified visualization obtained by the dual-channel endoscope and tremor-free instruments controlled by robot system helped surgeon do sharp and precise endoscopic dissection. Results: We performed 84 less-than total and 16 total thyroidectomies with ipsilateral central compartment node dissection. Mean operation times was 136.5 min. (range 79∼267 min.) in which the actual time for thyroidectomy with lymphadenectomy (console time) was 60.0 min. (range 25∼157 min). The average number of lymph nodes resected was 5.3 (range 1 to 28). There was no serious complication. Most patients could go home within 3 days after surgery. Conclusion: Our technique of robotic-assisted endoscopic thyroid surgery using a gasless trans-axillary approach is feasible, safe and promising for the selected patients with thyroid cancer. We suggest application of robotic technology for endsocopic thyroid surgeries could overcome the limitations of conventional endoscopic surgeries in the surgical management of thyroid cancer.

단일 기관에서 시행한 로봇 내시경 갑상선 절제술 256예의 경험

원태완,이광만,최운정,Tae Wan Won,Kwang Man Lee,Un Jong Choi 대한갑상선-내분비외과학회 2014 The Koreran journal of Endocrine Surgery Vol.14 No.4

Purpose: Conventional thyroidectomy through a skin crease incision in the anterior neck sometimes causes a visible scar. Minimally invasive surgical techniques have been developed, and, recently, more various techniques of remote access surgery such as endoscopic and robotic thyroidectomy have been suggested and actively applied. Robotic thyroid surgery has several advantages over endoscopic thyroid surgery. These advantages include three-dimensional magnified view, tremor-filtering system, multi-articulated motion, and more comfortable surgeon position, and assistants are unnecessary for performance of the robotic thyroid surgery. Methods: From November 2008 to July 2014, 256 patients underwent robotic endoscopic thyroidectomies through a transaxillary approach. An approximately 5 cm long incision was created on the axillary natural crease, so that the scar can be completely hidden by the arm. Patients' characteristics, postoperative clinical results, complications, and pathologic details were assessed. Results: The mean age of patients was 40.9±10.1 years. For benign tumors, we performed 56 less-than total thyroidectomies. For malignant tumors, we performed 175 less-than total thyroidectomies with central compartment node dissection, 21 total thyroidectomies with central compartment node dissection, and four total thyroidectomies with lateral neck node dissection (Benign=56, Malignant=200). The mean actual operation time (console time) was 91.5±48.7 min for benign tumors and 103.0±65.8 min for malignant tumors. The number of retrieved lymph nodes was 5.1±4.1 (mean) in malignant tumors. Internal jugular vein tearing occurred in two patients. Transient hypocalcemia (four patients) and transient hoarseness (six patients) occurred, but recovered within six months. Conclusion: Robotic endoscopic thyroidectomy is technically safe and feasible and also shows excellent cosmetic outcome.

갑상선유두암 수술의 이해-로봇 갑상선 수술

고윤우 대한이비인후과학회 부산,울산,경남 지부회 2013 임상이비인후과 Vol.24 No.2

양측 액와유륜부 접근법을 이용한 무배액관 로봇 또는 내시경하 갑상선 절제술의 안정성에 대한 예비연구

문소향(So Hyang Moon),전영산(Young San Jeon),김완욱(Wan Wook Kim),강수환(Su Hwan Kang),정영주(Young Ju Jeong),최정은(Jung Eun Choi),조지형(Ji hyoung Cho) 대한갑상선-내분비외과학회 2015 The Koreran journal of Endocrine Surgery Vol.15 No.2

Purpose: The aim of this study was to evaluate the safety of robotic or endoscopic thyroidectomy via bilateral axillo-breast approach (BABA) without a drainage procedure. Methods: A total of 64 patients who underwent robotic or endoscopic thyroidectomy via BABA without a close suction drain between February and March 2012 were enrolled. We checked postoperative symptoms or signs including change of vital signs, dyspnea, swelling or fluctuation of anterior chest and neck and compression symptoms at 1, 6, 24, and 48 hours and 1 month after surgery. Postoperative ultrasonography was performed in patients with at least one or more postoperative symptoms or signs in order to confirm hematoma or fluid collection. Results: None of the enrolled patients had dyspnea or change of vital signs. Two of 64 patients had swelling, 1 of 64 patients had fluctuation on the anterior chest, and 1 of 64 patients had compression symptoms. Fluid collection was confirmed in 2 of 4 of the above mentioned patients and the collected fluid was aspirated. The amounts of aspirated fluid were 25 mL and 8 mL. Thereafter, the follow up ultrasonography showed no more fluid collection in all patients. In addition, we rechecked the above mentioned symptoms or signs at 1 month after surgery; none of the enrolled patients had symptoms or signs. Conclusion: Robotic or endoscopic thyroidectomy via BABA without a closed suction drain shows no serious seroma or hematoma collection. Therefore, we expect that robotic or endoscopic thyroidectomy via BABA without a closed suction drain can reduce the pain, discomfort or longer hospital stay as a result of closed suction drain using this method.

경액와 액와부 접근법 로봇 갑상선 수술 후 삶의 질 변화

이잔디,정웅윤 대한갑상선학회 2015 International Journal of Thyroidology Vol.8 No.1

The robotic approach is the new frontier of thyroid cancer surgery, with several advantages over conventional open and endoscopic techniques. Recent assessments of quality of life (QoL) outcomes have found that patients undergoing robotic thyroid surgery using transaxillary approach experience lower levels of dissatisfaction and regret than patients undergoing conventional open thyroid surgery, largely due to differences in cosmetic outcomes. Prospective trials evaluating functional parameters, including pain, neck discomfort, and sensory changes in the neck, have favored robotic over conventional open thyroid surgery. Similarly, objective and subjective evaluations of voice and swallowing discomfort were improved in patients undergoing robotic thyroidectomy. Thus, use of a robot results in overall increases in cosmetic satisfaction and decreases in several measures of postoperative discomfort compared with the conventional open thyroid technique. However, a proper evaluation of QoL requires long-term assessments, and randomized controlled trials are necessary to definitively establish the real benefits of robotic surgery. This review provides merits and demerits of robotic thyroidectomy and radical neck dissection, based on published data, as well as comparing QoL outcomes after robotic and conventional open thyroidectomy.