단일 기관에서 시행한 로봇 내시경 갑상선 절제술 256예의 경험
Robotic Endoscopic Thyroidectomy; Experience with 256 Consecutive Cases in a Single Institution
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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.
Abstract
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.
참고문헌 (20)
- 최준영, "갑상선 수술의 비전: 과거와 현재, 그리고 미래", International Journal of Thyroidology, 5(1), pp.1~5 (2012), 대한갑상선학회
- Alvarado R, "Minimally invasive thyroid surgery for single nodules: an evidence-based review of the lateral mini-incision technique", World J Surg, 32, pp.1341~1348 (2008)
- Miccoli P, "Minimally invasive video-assisted thyroidectomy for benign thyroid disease: an evidence-based review", World J Surg, 32, pp.1333~1340 (2008)
- Lobe TE, "Novel uses of surgical robotics in head and neck surgery", J Laparoendosc Adv Surg Tech A, 15, pp.647~652 (2005)
- Bodner J, "Robotic resection of an ectopic goiter in the mediastinum", Surg Laparosc Endosc Percutan Tech, 15, pp.249~251 (2005)
- Lee J, "Perioperative clinical outcomes after robotic thyroidectomy for thyroid carcinoma: a multicenter study", Surg Endosc, 25, pp.906~912 (2011)
- Yoon JH, "Gasless endoscopic thyroidectomy via an axillary approach: experience of 30 cases", Surg Laparosc Endosc Percutan Tech, 16, pp.226~231 (2006)
- Choe JH, "Endoscopic thyroidectomy using a new bilateral axillo-breast approach", World J Surg, 31, pp.601~606 (2007)
- Slotema ET, "What is the evidence for endoscopic thyroidectomy in the management of benign thyroid disease?", World J Surg, 32, pp.1325~1332 (2008)
- Brunaud L, "Incision length for standard thyroidectomy and parathyroidectomy:when is it minimally invasive?", Arch Surg, 138, pp.1140~1143 (2003)
- 강선미, "측경부 최소침습절개술을 이용한 갑상선 일엽절제술의 효용성", 대한내분비외과학회지, 12(4), pp.258~263 (2012), 대한갑상선-내분비외과학회
- Gagner M, "Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism", Br J Surg, 83, pp.875~ (1996)
- Hüscher CS, "Endoscopic right thyroid lobectomy", Surg Endosc, 11, pp.877~ (1997)
- Ikeda Y, "Clinical benefits in endoscopic thyroidectomy by the axillary approach", J Am Coll Surg, 196, pp.189~195 (2003)
- Koh YW, "Endoscopic thyroidectomy via a unilateral axillo-breast approach without gas insufflation for unilateral benign thyroid lesions", Surg Endosc, 23, pp.2053~2060 (2009)
- Kang SW, "Gasless endoscopic thyroidectomy using trans-axillary approach; surgical outcome of 581 patients", Endocr J, 56, pp.361~369 (2009)
- Spinelli C, "Minimally invasive video-assisted thyroidectomy in pediatric patients", J Pediatr Surg, 43, pp.1259~1261 (2008)
- Miyano G, "Bilateral transaxillary endoscopic total thyroidectomy", J Pediatr Surg, 43, pp.299~303 (2008)
- Lee J, "Multicenter study of robotic thyroidectomy: short-term postoperative outcomes and surgeon ergonomic considerations", Ann Surg Oncol, 18, pp.2538~2547 (2011)
- Lee J, "Robotic versus endoscopic thyroidectomy for thyroid cancers: a multi-institutional analysis of early postoperative outcomes and surgical learning curves", J Oncol, 2012, pp.734541~ (2012)