J Endocr Surg.  2019 Sep;19(3):59-67. 10.16956/jes.2019.19.3.59.

Initial Experience of BABA Robotic Thyroidectomy Using the Da Vinci Xi System in Incheon, Korea

• Yoon HJ
• Ahn JH
• Kim JH
• Yi JW
• Hur MH

• KMID: 2458703
• DOI: http://doi.org/10.16956/jes.2019.19.3.59

Abstract

PURPOSE
The incidence of thyroid cancer in Korea is high, with the disease usually observed in young women. Thyroid cancer surgery should focus on both oncologic safety and good cosmetic outcomes. The bilateral axillo-breast approach (BABA) to thyroid surgery, which has been performed for over 10 years, has shown good oncologic and cosmetic outcomes. This study reports the initial results of robotic BABA thyroidectomy with the Da Vinci Xi system at Inha University Hospital in Incheon, Korea.
METHODS
This study included 53 patients who underwent BABA robotic thyroidectomy, performed by a single endocrine surgeon using the Da Vinci Xi system, between December 2018 and March 2019. Patients' medical records and surgery videos were retrospectively reviewed, and their clinical and surgical characteristics, pathological findings, and short-term postoperative outcomes were evaluated.
RESULTS
The 53 patients included 9 men and 44 women of mean age 44.51±10.36 years (range, 24-64 years). Mean robotic console times were 75.08±15.96 minutes for lobectomy and 93.53±17.86 minutes for total thyroidectomy. Forty-five patients were diagnosed with papillary thyroid carcinoma. Vocal cord palsy occurred in one patient and transient hypocalcemia in 8, with all resolving after 2 months. Cosmetic outcomes were excellent and there were no serious or unexpected complications.
CONCLUSION
BABA robotic thyroid surgery using the Da Vinci Xi system was successfully started at a hospital in Inchon, Korea. Long-term prospective cohort studies including larger numbers of patients are required to assess outcomes.

Keyword

Thyroid cancer; Robotics; Minimally invasive surgical procedures; Thyroidectomy

MeSH Terms

Cohort Studies
Female
Humans
Hypocalcemia
Incheon*
Incidence
Korea*
Male
Medical Records
Minimally Invasive Surgical Procedures
Prospective Studies
Retrospective Studies
Robotics
Thyroid Gland
Thyroid Neoplasms
Thyroidectomy*
Vocal Cord Paralysis

Figure

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  Fig. 1 Flap design and insertion of trocars. (A) Flap design of bilateral axillo-breast approach. (B) The 8 mm trocars were inserted.

• 

  Fig. 2 Procedures in robotic bilateral axillo-breast approach thyroidectomy. (A) Midline division and isthmectomy. (B) Divide the strap muscle from the thyroid gland. (C) Mobilization of thyroid lobe to superior-medial side (switching motion). (D) Identification of recurrent laryngeal nerve. (E) Saving lower parathyroid. (F) Thyroid was dissected from the trachea to Berry's ligament. (G) Ligation of superior pole with preservation of superior parathyroid. (H) Central node dissection.

• 

  Fig. 3 Cosmetic outcome after 1 month from the robotic bilateral axillo-breast approach surgery. (A) Neck and clavicular area. (B) Breast and axillary area.

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