로봇 갑상선 수술의 현재와 미래

정웅윤,Woong Youn Chung,M,D,Ph,D 대한갑상선-내분비외과학회 2012 The Koreran journal of Endocrine Surgery Vol.12 No.1

Since the introduction of robotic thyroid surgery in 2007, robotic thyroidectomy has become an effective and acceptable treatment for patients with thyroid cancer. Although Conventional open thyroidectomy is safe; the operative time is short and good oncologic outcomes are attained and robotic thyroidectomy is as yet not greatly advanced, many surgeons now use the modality in routine practice. Moreover, the results of robotic thyroidectomy have generated worldwide interest in minimally invasivesurgery and have encouraged several centers in Korea and the United States to develop aims identical to those set when conventional surgery is employed; the postoperative outcomes are better and cosmetic satisfaction is improved. Robotic procedures originated from open and endoscopic thyroidectomy procedures, and advances in the field should be compared with those of conventional open and endoscopic thyroidectomy. Short- and long-term oncologic outcomes must be assessed carefully, and cosmetic results and functional outcomes, such as voice and swallowing changes, require accurate objective analysis. The clinical reports on the conduct of robotic thyroid surgery via a gasless transaxillary approach showed that robotic surgery performed by experienced specialized endocrine surgeons afforded identical or superior levels of surgical radicality and oncologic safety compared to use of conventional open or endoscopic surgery in patients with thyroid carcinoma. The short-term oncologic effectiveness of thyroid surgery is assessed by measuring serum thyroglobulin (Tg) concentration via [<SUP>131</SUP>I] iodine (<SUP>131</SUP>RI) scanning, whereas long-term effectiveness is evaluated via lack of tumor recurrence. Moreover, functional outcomes increasingly emphasize high scores on validated quality-of-life (QOL) instruments. Several large-volume centers have reported the "functional and QOL" outcomes of patients who have undergone robotic thyroidectomy. In such patients, the clinical benefits of robotic thyroidectomy include excellent cosmetic results, reduced pain, improvement in swallowing function, and low morbidity rates. From the viewpoint of surgeons, robotic surgery shortens the surgical learning curve, and causes less musculoskeletal discomfort compared with the conduct of open or endoscopic surgery. The accumulated evidence to date suggests that robotic thyroidectomy and MRND are both safe and feasible in thyroid cancer patients, and can benefit both patients and surgeons. (Korean J Endocrine Surg 2012;12:1-10)

로봇 갑상선 수술

태경 대한이비인후과학회 2010 대한이비인후과학회지 두경부외과학 Vol.53 No.8

Conventional open thyroidectomy provides direct exposure to perform safe and quick operations with minimal morbidity and almost no mortality. However, the procedure leaves a scar on the anterior neck. Thyroid nodules are common in young women, who are interested not only in treatment of the disease but also in aesthetic results. As a result, a variety of minimally invasive techniques to minimize neck scars and surgical morbidity have been developed. The minimally invasive thyroidectomy technique includes mini open incision thyroidectomy, video assisted minimally invasive thyroidectomy, and pure endoscopic thyroidectomy. However, there are some limitations to endoscopic thyroidectomy in obtaining adequate surgical viewing angles,precisely manipulating endoscopic instruments and meticulously dissecting tissues. These limitations result from the narrow working space, two-dimensional operative views and the use of inadequate endoscopic instruments. Recently, robotic technology using the da Vinci surgical system robot has been applied to minimally invasive thyroid surgery to overcome the limitations of endoscopic thyroidectomy. The da Vinci surgical system robot provides a three-dimensional 10-12 x magnified view of the surgical area. It also provides hand-tremor filtration,fine motion scaling, and precise and multi-articulated hand-like motions. Robotic thyroidectomy by a gasless unilateral axillo-breast or axillary approach using da Vinci surgical system robot is safe, feasible and cosmetically excellent procedure in properly selected patients. It might have an advantage in the preservation of recurrent laryngeal nerve and parathyroid gland with magnified view. However, it is more invasive than open thyroidectomy. The postoperative pain or discomfort is comparable with open thyroidectomy. The oncologic safety of robotic thyroidectomy should be verified with long-term follow-up data. Korean J Otorhinolaryngol-Head Neck Surg 2010;53:463-9

Robotic thyroidectomy: Evolution and Outcomes

송창면,태경 한양대학교 의과대학 2016 Hanyang Medical Reviews Vol.36 No.4

Recently robotic thyroidectomy has gained its popularity for the treatment of differentiated thyroid cancer and benign thyroid tumors. It has been developed to overcome the drawbacks of conventional open trans-cervical thyroidectomy, which is an apparent neck wound that is visible unless concealed with clothes. Robotic thyroidectomy provides surgeons with three-dimensional magnified view and multiarticulated robotic arms that can stabilize hand tremors. It also has advantages over conventional trans-cervical thyroidectomy that include recovery of voice symptoms and acoustic parameters along with superior cosmetic outcomes. Robotic thyroidectomy results in equivalent surgical outcomes including oncologic safety and complications compared with conventional thyroidectomy. Various approaches including transaxillary, postauricular facelift, and breast-axillary approaches have been developed for robotic thyroidectomy. Recently, the indication of robotic surgery has been extended to neck dissection of the lateral compartment. Herein we summarize the indication, procedures, and efficacy of robotic thyroidectomy, and also introduce our experience with robotic thyroidectomy.

Robotic Thyroidectomy: Pros and Cons of Various Surgical Approaches

So hee Lee 대한갑상선-내분비외과학회 2015 The Koreran journal of Endocrine Surgery Vol.15 No.4

Robotic thyroidectomy has been a good option in the treatment of benign and early stage differentiated thyroid cancers, with several functional benefits. In the last few years, many surgeons have established their own robotic thyroidectomy techniques, and published many reports on the feasibility, safety and benefits of their robotic procedures. Although there are many different surgical techniques, robotic thyroidectomy can be classified according to the different means of remote access to the thyroid gland. Each method has advantages and disadvantages, and surgeons have modified each procedure in an effort to eliminate its shortcomings. With the remarkable innovation of robotic instruments and patient selection based on the appropriate indications, robotic thyroidectomy may usher a paradigm shift for thyroid surgery in the near future.

두경부 영역에서의 로봇 수술

태경,신광수,Tae, Kyung,Shin, Kwang-Soo 대한기관식도과학회 2010 大韓氣管食道科學會誌 Vol.16 No.1

Organ preservation surgery and minimally invasive surgery have been developed during the past 20 years with major focus on transoral laser surgery, endoscopic surgery, and robotic surgery. Two major robotic surgeries in head and neck area are transoral robotic surgery (TORS) and robotic thyroidectomy. Transoral robotic surgery is a safe and efficacious method of surgical treatment of oropharyngeal. hypopharyngeal and laryngeal neoplasm. Advantages of the technique include adequate ability to visualize and manipulate lesions with two hands. TORS can provide magnified three dimensional views and overcome the limitation resulting from the "line of sight" which hinders transoral laser procedure. The swallowing function following transoral robotic surgery show superior and patients were able to retain or rapidly regain swallowing function in the majority of cases. Recently, robotic thyroidectomy has also been developed to overcome the [imitation of endoscopic thyroidectomy. Robotic thyroidectomy by a gasless unilateral axillo-breast or axillary approach using a da Vinci S Surgical Robot is a feasible and cosmetically excellent procedure. It can be a promising alternative to endoscopic thyroidectomy or conventional open thyroidectomy.

무기하 액와 접근법을 이용한 로봇 갑상선 절제술: 단일 술자에 의한 최초 1년간의 경험

노재형,이정훈,나국영,이잔디,정웅윤<SUP>1<.SUP>,소의영,Jae Hyung Noh,Jeong Hun Lee,Kuk Young Na,Jandee Lee,Ph.D.,Woong Youn Chung Ph.D.<SUP>1 <.SUP>and Euy Young Soh,Ph.D. 대한갑상선-내분비외과학회 2010 The Koreran journal of Endocrine Surgery Vol.10 No.3

Purpose: Various endoscopic thyroidectomy procedures have been designed to minimize visible cervical scarring. However, endoscopic thyroidectomy is a technically challenging procedure that is performed by a limited surgeon. Robotic systems aida surgeon in performing minimally invasive head and neck surgery by offering superior visualization and dexterity. This study reports the initial experience of one surgeon with robotic thyroidectomy to assess the technical feasibility and safety of the approach. Methods: One hundred four thyroid cancer patients (97 females, 7 males; mean age of 39.8±8.1 years) underwent robotic thyroidectomy using gasless transaxillary approach between November 2008 and October 2009 in Ajou University Hospital. All the procedures were completed successfully using the da Vinci surgical system without open conversion. Patient characteristics, postoperative clinical results, complications, and pathologic details were assessed. Results: Total thyroidectomy was performed in 25 (24.0%) patients, subtotal thyroidectomy in 13 (12.5%) patients, and unilateral lobectomy in 66 (63.5%) patients. All patients underwent ipsilateral central compartment neck dissection, and two patients underwent selective lymph node (LN) dissection. The mean operation time was 134.5±47.2 min (range 61∼310 min), in which the actual time for the thyroidectomy with lymphadenectomy (console time) was 56.4 min. (range 31∼270). The mean number of LN resected was 3.9 (range 0∼28). There were no serious complications. The mean hospital stay was 2.9±0.9 days (range 2∼7). Conclusion: Robotic thyroidectomy is a feasible, safe, and cosmetically excellent procedure. The application of robotic technology for thyroid surgeries could be an alternative to endoscopic or conventional open thyroidectomy. (Korean J Endocrine Surg 2010;10:157-162)

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.

Robotic Transoral Thyroidectomy: Right Thyroidectomy and Ipsilateral Central Neck Dissection with da Vinci Si Surgical System

김효기,김훈엽,박다원,김홍규 대한내시경복강경외과학회 2019 Journal of Minimally Invasive Surgery Vol.22 No.1

Transoral approach for thyroidectomy recently gains a lot of attention among the thyroid surgeons, with the merits of cosmetic outcomes and minimal flap dissection. We’ve successfully introduced the robotic surgical system to the transoral approach for thyroidectomy. For transoral robotic thyroidectomy, we made 3 incisions in the gingival-buccal sulcus for three intraoral ports. An additional axilla port was inserted for counter-traction and later drain insertion. Herein, our unique procedures of transoral robotic thyroidectomy (TORT) are described in the treatment of a patient with papillary thyroid carcinoma.

Transoral Robotic Thyroidectomy: The Overview and Suggestions for Future Research in New Minimally Invasive Thyroid Surgery

추정민,김훈엽,유지영 대한내시경복강경외과학회 2019 Journal of Minimally Invasive Surgery Vol.22 No.1

Purpose of review: This journal introduces a overview in depth about the evolution of transoral robotic thyroidectomy, which has been encountering major confrontations in expanding its indications. Recent findings: Transoral robotic thyroidectomy (TORT) is one of the newest approaches and draws attention because of its cosmetic excellence. The major advantage of TORT is comparatively smaller flap dissection area than other remote-access methods. The other advantage of TORT is that the wounds of lips fades out over time, and leaves concealed scar near axilla. Summary: TORT can be done safely to the appropriately selected patients by surgeon expertise in robotic thyroidectomy. It might be a potential alternative surgical approach for thyroidectomy to surgeons who are experienced in remote-access robotic surgery.

Robotic Thyroidectomy: Pros and Cons of Various Surgical Approaches

이소희 대한갑상선-내분비외과학회 2015 The Koreran journal of Endocrine Surgery Vol.15 No.4

Robotic thyroidectomy has been a good option in the treatment of benign and early stage differentiated thyroid cancers, with several functional benefits. In the last few years, many surgeons have established their own robotic thyroidectomy techniques, and published many reports on the feasibility, safety and benefits of their robotic procedures. Although there are many different surgical techniques, robotic thyroidectomy can be classified according to the different means of remote access to the thyroid gland. Each method has advantages and disadvantages, and surgeons have modified each procedure in an effort to eliminate its shortcomings. With the remarkable innovation of robotic instruments and patient selection based on the appropriate indications, robotic thyroidectomy may usher a paradigm shift for thyroid surgery in the near future.