Die transaxilläre roboterassistierte Thyreoidektomie – Ergebnisse und Akzeptanz einer neuen Operationsmethode

Abstract

BACKGROUND: In recent years, different remote-access approaches in thyroid surgery have been developed and partially established. The aim is mainly to improve cosmetics by avoiding a visible scar on the neck. We report here our experiences with transaxillary robot-assisted thyroidectomy (TRAT). METHODS: As part of an observational trial, TRAT was offered to patients with indication for a hemithyroidectomy because of benign goitre with a lobe volume up to 40 ml. The acceptance of the new method and the surgical results, especially operation time and intra- and postoperative complications, were monitored and evaluated. In addition, patient satisfaction with the cosmetic results was recorded 8 to 12 weeks after surgery. RESULTS: From January 2013 to January 2018, TRAT was offered to 151 patients, of whom 65 (43.0%) chose this new surgical technique. 51 hemithyroidectomies, 6 isthmus resections and 8 Dunhill procedures were performed in these 65 patients. The mean operation time was 121.5 minutes (range 83 - 221) for isthmus resections, 165.0 minutes (range 100 - 300) for hemithyroidectomies and 259 minutes (range 197 - 320) for Dunhill resections. The rate of recurrent laryngeal nerve palsy was 8.2% (6 of 73 nerves at risk), of which 2 (2.7%) were permanent. Postoperative hypoparathyroidism or revisions due to bleeding did not appear and no tracheal, esophageal or vessel injuries. 9 patients (13.8%) suffered from transient paraesthesia of the skin flap. In 2 of the first 5 patients, transient brachial plexopathy occurred. 93% of all patients rated the cosmetic result as good or very good. The rate of recommendation was also 93%. CONCLUSION: TRAT for unilateral benign goitre is feasible and safe. The operation time is acceptable. TRAT is only used in Germany for selected patients because of low acceptance by the patients and high costs due to technical effort and its limitations to a large goitre.