OBJECTIVE:We reviewed our initial experience with robotic thy-roidectomy to identify challenges and limitations of this new surgical approach when applied to a North American population. STUDY DESIGN:Case series. SETTING:Academic institution. SUBJECTS/METHODS:Retrospective review of 18 consecutive robotic thyroid lobectomies performed from February 2010 to April 2012 involving 16 female patients. Two patients underwent robot-assisted completion thyroidectomy a few months following the initial thyroid surgery, one for cancer and the other for goiter. RESULTS:Median age was 47.5 years (range, 18-62 years), and median body mass index was 28.7 (range, 19.4-44.5). Median thyroid nodule size was 2.9 cm (range, 1.1-4.7 cm). All but 1 case (6%) was performed successfully via single axillary incision. There was no conversion to an open approach. Median operative time was 170 minutes (range, 95-220 minutes), and median blood loss was 12.5 mL (range, 5-75 mL). Complications occurred in 4 cases (22%) to include temporary vocal cord pareses (n = 3) and a postoperative hematoma that required exploration. Median hospital stay was 2 days (range, 1-3 days). CONCLUSION:Single-incision transaxillary robotic thyroidectomy can be technically challenging in North American patients with a larger body frame due to difficulty in optimal placement of all 4 robotic instruments via a single axillary incision. All 3 cases of temporary vocal cord paresis occurred early in our experience and may have been due to our relative inexperience with this new approach and associated instrumentation. Other limitations include less than optimal visualization of the recurrent laryngeal nerve in the contralateral lobe as well as poor access to the substernal region. LEVEL OF EVIDENCE:4.

译文

目的:我们回顾了我们在机器人甲状腺切除术方面的初步经验,以确定在将这种新手术方法应用于北美人群时所面临的挑战和局限性。
研究设计:案例系列。
单位:学术机构。
受试者/方法:回顾性回顾了从2010年2月至2012年4月进行的18例机器人甲状腺叶切除术,涉及16例女性患者。在最初的甲状腺手术后的几个月,两名患者接受了机器人辅助的全甲状腺切除术,其中一名癌症,另一名甲状腺肿。
结果:中位年龄为47.5岁(范围18-62岁),中位体重指数为28.7(范围19.4-44.5)。甲状腺结节中值大小为2.9厘米(范围为1.1-4.7厘米)。除1例(6%)外,其余所有病例均通过单根腋窝切口成功完成。没有转换为开放方法。中位手术时间为170分钟(范围为95-220分钟),中位数失血为12.5毫升(范围为5-75毫升)。 4例(22%)发生并发症,包括暂时性声带轻视(n = 3)和需要探查的术后血肿。中位住院天数为2天(范围为1-3天)。
结论:单身穿刺式腋窝机器人甲状腺切除术在体型较大的北美患者中可能具有技术挑战,因为难以通过单个腋窝切口最佳地放置所有四种机器人器械。在我们的经验中,所有3例临时性声带轻瘫均发生在早期,可能是由于我们相对缺乏这种新方法和相关器械的经验。其他限制包括对侧肺叶中喉返神经的最佳可视化效果欠佳,以及难以接近胸骨下区域。
证据级别:4。

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