Comparison Of The Efficacy Of Robotic Thyroidectomy With The Right Axillary-Bilateral Areola Approach And Traditional Surgery

Objective:To explore the safety and short-term efficacy of Da Vinci robotic thyroidectomy via the right axillary-bilateral areola approach.Methods:A retrospective analysis was performed on 185 patients diagnosed with thyroid cancer who underwent thyroidectomy at the general surgery Department of the 940th Hospital of the Joint Logistics Support Force of the Chinese People’s Liberation Army from January2018 to June 2021.Among them,87 patients underwent Da Vinci robot assisted surgery(robot surgery group)and 98 patients underwent traditional open surgery(traditional operation group).The follow-up data were intercepted until 3 months after operation.The operation time,intraoperative blood loss,incidence of intraoperative nerve injury,incidence of intraoperative parathyroid injury,central lymph node dissection,drainage days,total drainage fluid,incision complication rate,postoperative pain score,postoperative feeling of the operation area in 3 months,cosmetic score of incision at 3 months postoperatively and other indicators were compared and analyzed between the two groups.Results:There was no significant difference between the two groups in tumor location,tumor diameter,gender,body mass index,central lymph node dissection,drainage days,total drainage fluid,nerve injury rate,incidence of incision complications,and 72h postoperative pain score(P>0.05).Compared with the traditional surgery group,the patients in the robotic surgery group were generally younger[(38.60±10.00)y vs(45.95±10.79)y,t=-4.786,P<0.001],longer operation time[(178.80±43.58)min vs(136.19±43.22)min,t=6.667,P<0.001],less intraoperative blood loss[(27.01±21.81)ml vs(36.84±30.31)ml,t=-2.502,P=0.013],lower the incidence of parathyroid gland injury(26.44%vs42.86%,X~2=5.452,P=0.020),less the pain degree at 24 hours after surgery[(3.33±0.58)points vs(4.47±0.68)points,t=-12.149,P<0.001],and also milder the pain degree at 48 hours after surgery[(1.62±0.58)points vs(2.19±0.73)points,t=-5.893,P<0.001],lower the incidence of neck sensory abnormality in the postoperative 3 months(3.45%vs11.22%,X~2=3.984,P=0.046),and higher the cosmetic score of incision at 3 months after surgery[(8.60±1.08)points vs(5.39±1.12)points,t=19.777,P<0.001].the difference was statistically significant between the two groups.Conclusion:Da Vinci robotic thyroidectomy with the right axillary-bilateral areola approach is safe in the surgical treatment of patients with early thyroid cancer,and the short-term efficacy is accurate.It has more advantages in reducing the amount of intraoperative blood loss and protecting the parathyroid glands,and the postoperative patients generally have lower pain and better cosmetic effects.Therefore,this approach can be used as one of the surgical paths of the Da Vinci robot thyroidectomy,and can also provide a reference for clinicians in the selection of surgical paths in the future.