Abstract:

Background and purpose: Robotic thyroid surgery has been carried out worldwide since Kang first applied it to the thyroid in 2007. The proportion of axillary approach is increasing rapidly in China due to the continuous verification of safety, radicalness and cosmetic properties of cancer treatment. The advantages and clinical value of Da Vinci Xi robotic unilateral axillary approach in the treatment of unilateral papillary thyroid microcarcinoma (PTMC) was investigated by comparing and analyzing the clinical efficacy in 95 patients undergoing a gasless, unilateral axillary approach Da Vinci Xi robotic thyroid surgery for PTMC and 91 patients undergoing conventional surgery. Methods: The clinical data of 186 cases of unilateral PTMC undergoing thyroidectomy in the Department of Head and Neck Surgery of Shanghai cancer Hospital from March 2020 to November 2021 were retrospectively analyzed, and they were divided into the robotic group (95 cases) and the open group (91 cases) according to the surgical methods. The general clinical data, surgical results, postoperative complications, satisfaction of incision, learning curve and surgical costs were analyzed and compared between the two groups. Results: There was no statistically significant difference between the two groups in gender, age, incidence of Hashimoto’s thyroiditis, tumor diameter, location and number of lesions (P>0.05). However, the operation time was significantly longer in the robotic group [(126.65±34.76) min]than in the open group [(60.99±21.12) min], and after 36 operations, the operation time reached a stable level. The operation cost was significantly higher in the robotic group [(47 940.66±4 404.30) yuan] than in the open group [(15 807.73±2 295.35) yuan]. There was no significant difference in intraoperative hemorrhage [robotic group: (20.48±18.83) mL; open group: (16.15±13.95) mL], the number of removed lymph nodes (robotic group: 2.61±2.77; open group: 2.97±2.20) and the number of positive lymph nodes (robotic group: 1.01±1.61; open group: 0.78±1.36) between the two groups (P>0.05). The incidence of postoperative temporary vocal hoarseness and transient hypocalcemia was lower in the robotic group (1.10%, 2.10%, respectively) than in the open group (2.20%, 3.30%, respectively), however there was no statistically significant difference (P>0.05). The postoperative satisfaction of incision was significantly higher in the robotic group (very satisfied 87.4%, satisfied 11.6%) than in the open group (very satisfied 71.4%, satisfied 26.4%), and the difference was statistically significant (P<0.05). Conclusion: Da Vinci Xi robot in thyroid surgery using a gasless, unilateral axillary approach has not only good cosmetic effect and high patient satisfaction, but also short learning curve. The amount of bleeding during the surgery, the lymph node detection and the occurrence of postoperative complications are comparable to the traditional surgery.

Key words: Papillary thyroid microcarcinoma, Da Vinci Xi robot, Conventional open surgery, Thyroidectomy