Robotic surgery of the thyroid gland

Objective: to introduce the robot-assisted surgical treatment of patients with malignant and benign tumors of the thyroid gland (TG) into clinical practice. As the incidence of thyroid cancer increases, partly due to earlier detection and more sensitive diagnostic methods, the number of thyroid lobectomy and total thyroidectomy (TE) also increases. An increase in the number of patients in this group requires the development of new surgical approaches. Over the years, several methods have been developed and implemented to minimize or eliminate the incision in the neck that is classically associated with thyroid surgery. To prove the effectiveness and rationality of the use of robotic thyroid surgery from remote access is one of the tasks of modern surgery. The prospects of this area are proved based on the lesser trauma, a small number of complications, as well as social and cosmetic significance associated with robot-assisted operations [1].

Material and methods. In the Oncology Center of Sechenov University, a technique has been developed for conducting robot-assisted hemi-TE in patients with small thyroid benign neoplasms (up to 30 mm in diameter) and in patients with early-stage thyroid malignant neoplasms (T1 – T2). 6 operations were successfully performed: 2 in patients with nodular goiter and autoimmune thyroiditis and 4 in patients with papillary thyroid cancer. The volume of the operation was determined based on the clinical data of each specific patient at an oncological consultation. 2 hemi-ТЕ were performed with central lymphatic dissection in patients with papillary thyroid cancer (T1), 1 hemi-ТЕ in patient with colloid goiter, 2 TE with central lymphodissection in patients with papillary thyroid cancer (T2), 1 TE in autoimmune thyroiditis.

Results. During operations, the conversion was not required. The average duration of the operation was 120 minutes. Minimal invasiveness of the robot-assisted operation reduces the duration of inpatient treatment, the period of disability, and, most importantly, provides a visible cosmetic effect.

Conclusion. Carrying out robot-assisted surgical interventions on the thyroid gland is technically feasible. The operation from the remote axillary access provides an excellent operational field of view, makes it easy to identify vital anatomical structures, and also significantly improves the cosmetic result and avoids scarring on the neck skin.

Key words: thyroid cancer, oncology of the head and neck, robotic surgery, axillary access.

Conflicts of interest. The authors have no conflicts of interest to declare.

Funding. There was no funding for this study.

For citation: Reshetov I.V., Sukortseva N.S., Shevalgin A.A., Agakina Y.S., Bagdasarov P.S., Gabaidze D.I., Nasilevsky P.A. Robotic surgery of the thyroid gland. Head and neck Russian Journal. 2020;8(2):8–15 (in Russian).

The authors are responsible for the originality of the data presented and the possibility of publishing illustrative material – tables, figures, photographs of patients.