The Surgical Completeness of Robotic thyroidectomy :

A prospective Comparative Study of Robotic versus conventional open thyroidectomy

in papillary thyroid carcinoma patients

Sohee Lee M.D., Seulkee Park M.D., Cho Rok Lee M.D., Haiyoung Son M.D., Jungwoo Kim M.D., Sang-Wook Kang M.D., Jong Ju Jeong M.D., Kee-Hyun Nam M.D.,

Woong Youn Chung M.D. and Cheong Soo Park M.D.

Department of SurgeryYonsei University Health System, Seoul, Korea

• Conventional open thyroidectomy with di-rect approach through the neck Most Effective and safe method Noticeable scar in highly visible area

Introduction

• Robotic thyroidectomy via transaxillary ap-proach Excellent cosmesis Short term outcome : comparable with conven-

tional open thyroidectomy in low risk papillary thyroid cancer patients

Introduction

• The oncologic safety with surgical radicality of robotic thyroidectomy should be prior to cosmesis in managing thyroid cancer

• Robotic thyroidectomy via trans axillary ap-proach has been criticized about complete excision of contralateral lobe

• The aim of this study :to show the surgical completeness of robotic thyroidectomy by comparing with conventional open thyroidectomy in papillary thyroid carcinoma

Introduction

• 110 patients with papillary thyroid carcinoma were enrolled from April, 2009 through February 2011

• All underwent total thyroidectomty and 30 mci RAI ablation therapy

• 55 underwent conventional open thyroidectomy55 underwent robotic thyroidectomy

• Definite extrathyroidal tumor invasion, lateral neck node metastases, perinodal infiltration at a metastatic lymph node, or distant metastasis were excluded

Patients and Methods

• Tumor located in the thyroid dorsal area (particularly at the tracheoesopheal groove) with posterior capsular invasion or extension to an adjacent structure were also excluded in robotic thyroidectomy

• Extent of surgery : According to the ATA guidelinesProphylactic ipsilateral CCND : performed for all the patients

• 12 patients were excluded ( ex. pregnancy, pt’s refusal) : three open thyroidectomynine robotic thyroidectomy

• Analysis of surgical completeness : Radioiodine uptake Postoperative serum Tg level

Patients and Methods

• Radioactive iodine uptakecalculate RAI uptake (%) in thyroid bed area (thyroid/whole body, thyroid/brain)

30mci RAI ablation therapy at postoperative 2~3 months

Diagnostic scan at 1 year after 1st RAI ablation Before 131-I Tx, at least 3-4 weeks Levothyrox-

ine withdrawal with low iodine diet or rhTSH adminis-tration

pre RAI TSH level > 30 μIU/mL

Patients and Methods

• Serum Tg level TSH stimulated Tg at 1st RAI ablation and

diagnostic scan TSH suppressed Tg : 6 month after RAI

therapy

• The patient’s clinicopathologic characteristics, surgical outcomes, RAI uptake, serum Tg level were compared between the two groups.

Patients and Methods

Conventional open thyroidectomy

(N=52)

Robotic thyroidectomy

(N=46)P value

Age(year) 48.3±10.6 40.4±10.4 <0.001

Gender M:F (ratio) 11:41 3:43 0.046

Operation time(min) 95.3±26.5 130.3±29.9 <0.001

Tumor maximal size(cm) 1.03±0.54 1.02±0.43 0.943

Extracapsular invasion No 9(17.3%) 5(10.9%) 0.402

Yes 43(82.70%) 41(89.1%)

Multiplicity No 36(69.2%) 47(58.7%) 0.299

Yes 16(30.8%) 19(41.3%)

Bilaterality No 49(94.2%) 45(97.8%) 0.620

Yes 3(5.8%) 1(2.2%)

T stage 1 9(17.3%) 5(10.9%) 0.402

3 43(82.7%) 42(89.1%)

N stage 0 25(49.0%) 27 (58.7%) 0.416

1a 22(41.5%) 19(41.3%)

Stage 1 21(41.2%) 32(69.6%) 0.008

3 30(58.8%) 14(30.4%)

Results

Conventional

open thyroidectomy

(N=52)

Robotic

thyroidectomy

(N=46)

P value

Retrieved central node number (N) 6.3±4.2 4.9±2.9 0.074

Radioactive iodine uptake at 30mci RAI ablation

Thyroid bed/ Brain ratio 9.122±9.516 23.510±34.786 0.009

Thyroid bed/ Whole body ratio 0.044±0.047 0.097±0.083 <0.001

Radioactive iodine uptake at diagnostic scan after 1st ablation†

Thyroid bed/ Brain ratio 1.574±1.021 1.480±0.577 0.580

Thyroid bed/ Whole body ratio 0.007±0.004 0.008±0.004 0.455

Stimulated serum Tg level at 30mci RAI ablation(ng/ml) 3.17±8.93 5.66±7.51 0.141

Suppressed serum Tg level after 1st ablation(ng/ml) 0.27±0.323 0.38±0.61 0.275

Stimulated serum Tg level at diagnostic scan(ng/ml) 1.84±7.67 3.35±9.10 0.385

Results

† Diagnostic scan was performed at 12months later after 1st RAI ablation

Robotic thyroidectomy showed significant high uptake at RAI ablation therapy compared with conventional open thyroidectomy.

However, stimulated Tg level at RAI therapy showed no significant difference between two groups.

Remnant thyroid tissue after robotic thy-roidectomy can successfully managed by 30mci RAI ablations.(RAI uptake, stimulated Tg at diagnostic scan show no differences between two groups.)

Robotic thyroidectomy is safe and feasible in managing low risk papillary thyroid carcinoma patients

Conclusion

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