Re-do Transoral Robotic Thyroidectomy is Feasible: Preliminary Results of the Surgical Feasibility and Efficacy of Completion Transoral Robotic Thyroidectomy: Cohort Study

Overview

Journal Int J Surg

Specialty General Surgery

Date 2024 Feb 16

PMID 38363985

Authors

Moon Young Oh

Dawon Park

Young Jun Chai

Kwangsoon Kim

Hoon Yub Kim

Affiliations

Soon will be listed here.

Abstract

Background: Transoral robotic thyroidectomy (TORT) has proven to be a safe and effective procedure with favourable surgical and cosmetic outcomes, but its application in completion thyroidectomy procedures remains to be established. In this study, the authors present our experience with completion TORT, assessing its surgical feasibility and efficacy. between February 2017 and August 2023.

Methods: The authors conducted a retrospective analysis of consecutive patients who underwent completion TORT after an initial TORT procedure between February 2017 and August 2023.

Results: A total of 10 patients (three males and seven females) were included in the study, with a mean age of 42.2±13.5 years. The indications for completion thyroidectomy included five cases of aggressive initial lesions and five cases of metachronous papillary thyroid carcinoma detected in the remnant lobe. The median interval between the initial and completion TORT procedures was 6.5 months. Flap dissection time showed no significant difference between the initial TORT and completion TORT operations (43.3±7.5 vs. 36.2±11.2, P =0.125). However, the mean console time (127.9±42.6 vs. 86.4±26.3 min, P =0.019) and mean total operation time (206.7±65.9 vs. 146.0±34.9 min, P =0.021) were significantly longer during the initial TORT procedure than during the completion TORT procedure. Two patients experienced transient hypoparathyroidism, which resolved within four weeks postoperatively. No other complications, such as vocal cord palsy, mental nerve injury, or bleeding, were observed. The median follow-up period was 21.5 months, and no recurrences were detected in any of the patients.

Conclusions: Our study demonstrates that re-do TORT is feasible, showing excellent cosmetic results and minimal adverse effects. Completion TORT may be considered a viable option for selected patients who require completion thyroidectomy after an initial TORT procedure.

Citing Articles

Redo Thyroidectomy: Updated Insights.

Suveica L, Sima O, Ciobica M, Nistor C, Cucu A, Costachescu M J Clin Med. 2024; 13(18).

PMID: 39336834 PMC: 11432308. DOI: 10.3390/jcm13185347.

References

Kim H, Park D, Kim H . Robotic transoral thyroidectomy for papillary thyroid carcinoma. Ann Surg Treat Res. 2019; 96(5):266-268. PMC: 6483931. DOI: 10.4174/astr.2019.96.5.266. View

Shaha A, Jaffe B . Completion thyroidectomy: a critical appraisal. Surgery. 1992; 112(6):1148-52; discussion 1152-3. View

Lefevre J, Tresallet C, Leenhardt L, Jublanc C, Chigot J, Menegaux F . Reoperative surgery for thyroid disease. Langenbecks Arch Surg. 2007; 392(6):685-91. DOI: 10.1007/s00423-007-0201-6. View

Kim D, Kim K, Lee J, Ho J, Kim J, Kang S . Re-do Operation Using a Robotic System due to Locoregional Recurrence after Initial Thyroidectomy for Thyroid Cancer. Sci Rep. 2022; 12(1):11531. PMC: 9262981. DOI: 10.1038/s41598-022-15908-x. View

Oh M, Chai Y, Yu H, Kim S, Choi J, Lee K . Transoral endoscopic thyroidectomy vestibular approach vs. transoral robotic thyroidectomy: systematic review and meta-analysis. Updates Surg. 2023; 75(7):1773-1781. DOI: 10.1007/s13304-023-01623-3. View

Kang Y, Cho J, Stybayeva G, Hwang S . Safety and Efficacy of Transoral Robotic Thyroidectomy for Thyroid Tumor: A Systematic Review and Meta-Analysis. Cancers (Basel). 2022; 14(17). PMC: 9454701. DOI: 10.3390/cancers14174230. View

Haugen B, Alexander E, Bible K, Doherty G, Mandel S, Nikiforov Y . 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2015; 26(1):1-133. PMC: 4739132. DOI: 10.1089/thy.2015.0020. View

Kim H, Park D, Bertelli A . The pros and cons of additional axillary arm for transoral robotic thyroidectomy. World J Otorhinolaryngol Head Neck Surg. 2020; 6(3):161-164. PMC: 7548390. DOI: 10.1016/j.wjorl.2020.01.010. View

You J, Kim H, Park D, Yang H, Kim H, Dionigi G . Transoral robotic thyroidectomy versus conventional open thyroidectomy: comparative analysis of surgical outcomes using propensity score matching. Surg Endosc. 2020; 35(1):124-129. DOI: 10.1007/s00464-020-07369-y. View

10.

Dhir M, McCoy K, Ohori N, Adkisson C, LeBeau S, Carty S . Correct extent of thyroidectomy is poorly predicted preoperatively by the guidelines of the American Thyroid Association for low and intermediate risk thyroid cancers. Surgery. 2017; 163(1):81-87. DOI: 10.1016/j.surg.2017.04.029. View

11.

Kim H, Chai Y, Dionigi G, Anuwong A, Richmon J . Transoral robotic thyroidectomy: lessons learned from an initial consecutive series of 24 patients. Surg Endosc. 2017; 32(2):688-694. DOI: 10.1007/s00464-017-5724-5. View

12.

Stang M, Yip L, Wharry L, Bartlett D, McCoy K, Carty S . Gasless Transaxillary Endoscopic Thyroidectomy with Robotic Assistance: A High-Volume Experience in North America. Thyroid. 2018; 28(12):1655-1661. DOI: 10.1089/thy.2018.0404. View

13.

Medas F, Tuveri M, Canu G, Erdas E, Calo P . Complications after reoperative thyroid surgery: retrospective evaluation of 152 consecutive cases. Updates Surg. 2019; 71(4):705-710. DOI: 10.1007/s13304-019-00647-y. View

14.

Duenas J, Duque C, Cristancho L, Mendez M . Completion thyroidectomy: is timing important for transcervical and remote access approaches?. World J Otorhinolaryngol Head Neck Surg. 2020; 6(3):165-170. PMC: 7548381. DOI: 10.1016/j.wjorl.2020.02.006. View

15.

Richer S, Wenig B . Changes in surgical anatomy following thyroidectomy. Otolaryngol Clin North Am. 2008; 41(6):1069-78, vii. DOI: 10.1016/j.otc.2008.06.001. View

16.

Park K, Lee K, Ku D, Kim S, Park W, Kim H . Antiadhesive effect and safety of oxidized regenerated cellulose after thyroidectomy: a prospective, randomized controlled study. J Korean Surg Soc. 2013; 84(6):321-9. PMC: 3671000. DOI: 10.4174/jkss.2013.84.6.321. View

17.

Nicholson K, Teng C, McCoy K, Carty S, Yip L . Completion thyroidectomy: A risky undertaking?. Am J Surg. 2019; 218(4):695-699. DOI: 10.1016/j.amjsurg.2019.07.014. View

18.

Kim H, Chai Y, Dionigi G, Berber E, Tufano R, Kim H . Transoral Robotic Thyroidectomy for Papillary Thyroid Carcinoma: Perioperative Outcomes of 100 Consecutive Patients. World J Surg. 2018; 43(4):1038-1046. DOI: 10.1007/s00268-018-04877-w. View

19.

Erbil Y, Bozbora A, Ademoglu E, Salmaslioglu A, Ozarmagan S . Is timing important in thyroid reoperation?. J Otolaryngol Head Neck Surg. 2008; 37(1):56-64. View

20.

Kwak J, Kim S, Xu Z, Lee K, Ahn J, Yu H . Robotic Completion Thyroidectomy via the Bilateral Axillo-Breast Approach. J Clin Med. 2021; 10(8). PMC: 8071380. DOI: 10.3390/jcm10081707. View