Clinical application analysis of Da Vinci Xi robot in thyroid surgery using a gasless, unilateral axillary approach

Rongliang SHI; Tingting ZHANG; Yu WANG; Zhaoxian NI; Hui WANG; Yulong WANG; Wenjun WEI; Jun XIANG; Ning QU; Zhongwu LU; Juan FAN; Weijin GU; Qinghai JI

doi:10.19401/j.cnki.1007-3639.2023.11.007

您当前的位置：

首页 >

文章列表页 >

Clinical application analysis of Da Vinci Xi robot in thyroid surgery using a gasless, unilateral axillary approach

Article | 更新时间：2025-12-31

- Clinical application analysis of Da Vinci Xi robot in thyroid surgery using a gasless, unilateral axillary approach
- China Oncology Vol. 33, Issue 11, Pages: 1018-1025(2023)
- 作者机构：
  
  1. 复旦大学附属肿瘤医院头颈外科，复旦大学上海医学院肿瘤学系，上海 200032
  2. 复旦大学附属闵行医院普通外科，上海 201199
  3. 复旦大学附属肿瘤医院手术室，复旦大学上海医学院肿瘤学系，上海 200032
- 作者简介：
- 基金信息：
- DOI：10.19401/j.cnki.1007-3639.2023.11.007
  CLC： R736.1
- Received：27 June 2023，
  
  Revised：2023-10-27，
  
  Published：30 November 2023
- 稿件说明：
移动端阅览
Rongliang SHI, Tingting ZHANG, Yu WANG, et al. Clinical application analysis of Da Vinci Xi robot in thyroid surgery using a gasless, unilateral axillary approach[J]. China Oncology, 2023, 33(11): 1018-1025.
DOI：

Rongliang SHI, Tingting ZHANG, Yu WANG, et al. Clinical application analysis of Da Vinci Xi robot in thyroid surgery using a gasless, unilateral axillary approach[J]. China Oncology, 2023, 33(11): 1018-1025. DOI： 10.19401/j.cnki.1007-3639.2023.11.007.

摘要

背景和目的：

2007年，Kang等第1次将机器人手术应用于甲状腺，之后机器人甲状腺手术在全球范围内开展。因安全性、肿瘤治疗的根治性和美容性不断得到验证，腋窝入路比例在国内正在快速增长。本研究通过对比分析使用达芬奇Xi机器人完成的95例单侧腋窝入路免充气甲状腺手术与91例传统手术治疗cN

0期

甲状腺微小乳头状癌（papillary thyroid microcarcinoma，PTMC）的临床疗效，探讨达芬奇Xi机器人单侧腋窝入路手术治疗PTMC的优势及临床应用价值。

方法：

回顾性分析2020年3月—2021年11月复旦大学附属肿瘤医院头颈外科收治的186例cN

0期

单侧单灶PTMC患者的临床数据，根据手术方式分为机器人组（95例）和开放组（91例），分析比较两组患者的一般临床资料、手术结果、术后并发症、切口满意度、学习曲线及手术费用等情况。

结果：

两组患者在性别、年龄、是否合并桥本甲状腺炎、肿瘤直径及病灶位置方面差异无统计学意义（

0.05）。机器人组手术时间[（126.65±34.76）min

]

长于开放组[（60.99±21.12）min

]

，在经历36例手术后手术时间可达稳定水平。手术费用[（47 940.66±4 404.30）元

]

高于开放组[（15 807.73±2 295.35）元

]

。在术中出血量[机器人组：（20.48±18.83）mL；开放组：（16.15±13.95）mL

]

、清扫淋巴结个数[机器人组：（2.61±2.77）枚；开放组：（2.97±2.20）枚

]

和检出阳性淋巴结个数[机器人组：（1.01±1.61）枚；开放组：（0.78±1.36）枚

]

方面差异无统计学意义（

0.05）。机器人组术后暂时性声嘶（1.10%）低于开放组（2.20%），但差异无统计学意义（

0.05）。机器人组术后切口满意度（非常满意87.4%，比较满意11.6%）高于开放组（非常满意71.4%，比较满意26.4%），差异有统计学意义（

0.05）。

结论：

达芬奇Xi机器人单侧腋窝入路免充气甲状腺手术不仅具有良好的美容效果，较高的患者满意度，而且学习曲线短，术中出血量、淋巴结检测情况及术后并发症发生情况与传统手术相当。

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 an

d 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 (

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 (

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 (

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 (

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.

关键词

Keywords

references

KANG S W , JEONG J J , NAM K H , et al . Robot-assisted endoscopic thyroidectomy for thyroid malignancies using a gasless transaxillary approach [J ] . J Am Coll Surg , 2009 , 209 ( 2 ): e1 -e7.

QI X W , DU J Z , LIU H X , et al . First report of in situ preservation of a subcapsular parathyroid gland through super-meticulous capsular dissection during robotic radical thyroidectomy [J ] . Surg Oncol , 2019 , 28 : 9 - 13 . DOI: 10.1016/j.suronc.2018.10.009 http://doi.org/10.1016/j.suronc.2018.10.009 https://linkinghub.elsevier.com/retrieve/pii/S0960740418302329 https://linkinghub.elsevier.com/retrieve/pii/S0960740418302329

LIU P , ZHANG Y , QI X , et al . Unilateral axilla-bilateral areola approach for thyroidectomy by da vinci robot: 500 cases treated by the same surgeon [J ] . J Cancer , 2019 , 10 ( 16 ): 3851 - 3859 . DOI: 10.7150/jca.31463 http://doi.org/10.7150/jca.31463

郑传铭 , 徐加杰 , 蒋烈浩 , 等 . 无充气腋窝入路完全腔镜下甲状腺叶切除的方法: 葛-郑氏七步法 [J ] . 中国普通外科杂志 , 2019 , 28 ( 11 ): 1336 - 1341 .

ZHENG C M , XU J J , JIANG L H , et al . Endoscopic thyroid lobectomy by a gasless unilateral axillary approach: Ge & Zheng’s seven-step method [J ] . Chin J Gen Surg , 2019 , 28 ( 11 ): 1336 - 1341 .

ZHOU J F , SHI Y , QIAN F , et al . Cumulative summation analysis of learning curve for robot-assisted gastrectomy in gastric cancer [J ] . J Surg Oncol , 2015 , 111 ( 6 ): 760 - 767 . DOI: 10.1002/jso.23876 http://doi.org/10.1002/jso.23876

BOLSIN S , COLSON M . The use of the Cusum technique in the assessment of trainee competence in new procedures [J ] . Int J Qual Health Care , 2000 , 12 ( 5 ): 433 - 438 . DOI: 10.1093/intqhc/12.5.433 http://doi.org/10.1093/intqhc/12.5.433 https://academic.oup.com/intqhc/article-lookup/doi/10.1093/intqhc/12.5.433 https://academic.oup.com/intqhc/article-lookup/doi/10.1093/intqhc/12.5.433

MATERAZZI G , PAPINI P , FREGOLI L , et al . The learning curve on robot-assisted transaxillary thyroidectomy performed by a single endocrine surgeon in a third-level institution in Europe: a cumulative sum (CUSUM) analysis [J ] . Updates Surg , 2023 , 75 ( 6 ): 1653 - 1660 . DOI: 10.1007/s13304-023-01619-z http://doi.org/10.1007/s13304-023-01619-z

HÜSCHER C S , CHIODINI S , NAPOLITANO C , et al . Endoscopic right thyroid lobectomy [J ] . Surg Endosc , 1997 , 11 ( 8 ): 877 . DOI: 10.1007/s004649900476 http://doi.org/10.1007/s004649900476

LEE S , RYU H R , PARK J H , et al . Excellence in robotic thyroid surgery: a comparative study of robot-assisted versus conventional endoscopic thyroidectomy in papillary thyroid microcarcinoma patients [J ] . Ann Surg , 2011 , 253 ( 6 ): 1060 - 1066 . DOI: 10.1097/SLA.0b013e3182138b54 http://doi.org/10.1097/SLA.0b013e3182138b54

KIM S K , WOO J W , PARK I , et al . Propensity score-matched analysis of robotic versus endoscopic bilateral axillo-breast approach (BABA) thyroidectomy in papillary thyroid carcinoma [J ] . Langenbecks Arch Surg , 2017 , 402 ( 2 ): 243 - 250 . DOI: 10.1007/s00423-016-1528-7 http://doi.org/10.1007/s00423-016-1528-7 http://link.springer.com/10.1007/s00423-016-1528-7 http://link.springer.com/10.1007/s00423-016-1528-7

中国医师协会外科医师分会甲状腺外科医师委员会 , 中国研究型医院学会甲状腺疾病专业委员会 . 机器人手术系统辅助甲状腺和甲状旁腺手术专家共识 [J ] . 中国实用外科杂志 , 2016 , 36 ( 11 ): 1165 - 1170 . DOI: 10.7504/CJPS.ISSN1005-2208.2016.11.08 http://doi.org/10.7504/CJPS.ISSN1005-2208.2016.11.08

The Thyroid Surgeon Committee of the Surgical Branch of the Chinese Medical Doctor Association Consensus on Diagnosis , the Thyroid Disease Professional Committee of the Chinese Research Hospital Association . Expert consensus on robot-assisted thyroid and parathyroid surgery [J ] . Chin J Pract Surg , 2016 , 36 ( 11 ): 1165 - 1170 .

MATTEUCCI V , FREGOLI L , PAPINI P , et al . Comparison of surgical completeness in patients operated on conventional open total thyroidectomy (OT) or trans-axillary robot-assisted total thyroidectomy (RATT) by a single axillary approach [J ] . Updates Surg , 2023 , 75 ( 5 ): 1267 - 1275 . DOI: 10.1007/s13304-023-01510-x http://doi.org/10.1007/s13304-023-01510-x

KANG I K , PARK J , BAE J S , et al . Safety and feasibility of single-port trans-axillary robotic thyroidectomy: experience through consecutive 100 cases [J ] . Medicina (Kaunas) , 2022 , 58 ( 10 ): 1486 .

Views

1987

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

Interpretation of the 2025 American Thyroid Association Management Guidelines for Adult Patients with Differentiated Thyroid Cancer: advances in surgical treatment of differentiated thyroid cancer

The value ofBRAF^V600Eand TERT promoter mutation in risk assessment of papillary thyroid microcarcinoma

Preoperative prediction and intraoperative injury prevention of nonrecurrent laryngeal nerve

Related Author

Qian SHI

Jugao FANG

薛金才

刘勤江

田尤新

邹　贤

朱国华

孙志强

Related Institution

Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University

甘肃省肿瘤医院头颈外科

江苏省原子医学研究所附属江原医院普外科，无锡市甲状腺病研究所

AI问答

⁰