A Comparative Study On The Clinical Application Of Da Vinci Robotic And Endoscopic Thyroidectomy

Objective:To compare the surgical outcomes of robotic thyroidectomy via bilateral axillo-breast approach and endoscopic thyroidectomy via bilateral areola approach,and to analyze the value of robotic surgical system in thyroid surgery.Methods:From May 2013 to October 2022,864 patients thyroid tumors admitted to the China-Japan Union Hospital of Jilin University were collected and divided into a robotic group and a endoscopic group according to the surgical treatment.All surgeries were performed by the same surgeon.The basic information,pathological characteristics,and perioperative indicators of the patients were counted,and the differences between groups were compared.Result:A total of 864 patients were included in this study,including 500 in the roboticgroup and 364 in the endoscopic group,and all procedures were successfully completed without conversion to open surgery.In terms of basic characteristics,the median age and median BMI were higher in the robotic group compared with the endoscopic group,and a higher proportion of patients in the robotic group were older than or equal to 45years and had a BMI greater than or equal to 25 kg/m~2.With regard to pathological features,the percentage of malignant tumors and the percentage of thyroiditis were higher and the number of lymph nodes cleared was higher in the robotic group compared to the endoscopic group.In terms of perioperative outcomes,the robotic group had a shorter median operative time,shorter mean postoperative days,more total postoperative drainage,and higher costs compared with the endoscopic group.In terms of RLN injury,a total of 58 cases in the robotic group had EMG signal changes compared with 46 cases in the endoscopic group.The mechanisms of RLN injury in the robotic group were mainly compression(91.4%),tumor invasion(1.7%),and thermal injury(6.9%),while the causes of RLN injury in the endoscopic group were compression(78.3%),tumor invasion(4.3%)and thermal injury(17.4%),and the incidence of temporary postoperative vocal cord paralysis in the robotic group was less than that in the endoscopic group.In terms of learning curve,no significant learning curve was observed for endoscopic thyroidectomy,and the operating time of robotic thyroidectomy tended to shorten as the number of surgical cases increased,with a significant decrease in the 26th case,from the initial 340 min to 145 min,and then stabilized;using the 26th case as the cut-off point,the learning curve was divided into the initial stage and the mature stage,and compared with the initial stage,compared with the mature stage,the initial stage had a longer operation time,a greater proportion of benign tumors,a higher incidence of postoperative temporary vocal cord paralysis,and more postoperative drainage.Conclusion:1.The application of the da Vinci robotic surgical system in thyroidectomy is safe and feasible.2.Robotic thyroidectomy has an advantage over endoscopic thyroidectomy in central lymph node dissection.3.Compared with endoscopic thyroidectomy,robotic thyroidectomy can shorten the operation time,reduce postoperative complications,and accelerate postoperative recovery.4.There is a learning curve for robotic thyroidectomy,and beginners should give preference to patients with unilateral thyroid microcarcinoma to survive the learning curve in the early stages of the procedure.