Journal of the Korea Academia-Industrial cooperation Society (한국산학기술학회논문지)

The Korea Academia-Industrial cooperation Society (한국산학기술학회)
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Comparison of an Axillo-Breast Approach and Only-Axillary Approach in Robotic Endoscopic Thyroidectomy

로봇 내시경 갑상선 절제술의 액와-유륜 접근법과 유일-액와 접근법의 비교

  • Won, Tae Wan (Department of Surgery, Wonkwang University School of Medicine)
  • 원태완 (원광대학교 의과대학 외과학교실)
  • Received : 2015.09.24
  • Accepted : 2015.10.08
  • Published : 2015.10.31
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Abstract

Purpose: Various new techniques in thyroid surgery have been developed to improve visualization and reduce risk of complications. New approaches for robotic endoscopic thyroidectomy help to prevent neck scarring and improve surgical ergonomics. The purpose of this study was to compare the efficacy and adventages of an axillo-breast approach (AB group) and an only-axillary approach (OA group) in robotic endoscopic thyroidectomy. Methods: Between November 2008 and July 2014, axillo-breast approach was performed in 128 patients and only-axillary approach was performed in 128 patients for robotic endoscopic thyroidectomy. We compared tumor characteristics, surgical outcomes, and postoperative complications between the two approaches. The homogeneity between two groups of general characteristics was analyzed by independent t-test, fisher's exact test, Chi-square test. Results: There were no differences in terms of tumor characteristics, extent of thyroidectomy, retrieved nodes, and postoperative complications between the two approaches. The patients in OA group can avoid breast scar. Conclusion: Our techniques of AB and OA approaches for robotic endoscopic thyroidectomy are safe, feasible, and cosmetically excellent procedures. Also the OA approach for robotic endoscopic thyroidectomy is an attractive surgical option for patients with thyroid tumor who want an avoid breast scar.

서론: 통상적인 갑상선 암 수술시 생기는 목의 전면에 있는 흉터를 피하기 위해 여러 다양한 수술 기법들이 고안되고 있다. 저자들이 고안한 로봇 내시경 갑상선 수술법으로 수술을 시행 받은 256예를 대상으로 기구의 변화와 더불어 로봇 내시경적 수술방법(액와 유륜 접근법과 유일-액와 접근법)에 따라 수술 결과를 비교하여 각 수술 방법의 안정성 및 유용성을 확인하고자 하였다. 대상 및 방법: 2008년 11월부터 2014년 7월까지 로봇 내시경 갑상선 수술을 시행 받은 256명의 환자를 대상으로 하였다. 접근방법에 따라 2008년 11월부터 2010년 7월까지 액와-유륜 접근법(Axillo-Breast approach, AB group)이 128례, 2010년 8월부터 2014년 7월까지 유일-액와 접근법(Only-Axillary approach, OA group)이 128예로 구성되었다. 수집된 자료는 SPSS v.12 를 이용하여 실험군과 대조군의 동질성 검정은 independent t-test, fisher's exact test, $x^2$-test로 양측검정을 실시하였다. 결과: 종양의 특성, 수술범위, 채취된 평균 림프절 개수(AB group 5.1개, OA group 6.1개), 수술 후 주요 합병증(AB group 0.8%, OA group 0.8%)은 양 군간에 차이는 없었다. 유일-액와 접근법의 경우 유륜의 흉터를 피할 수 있었다. 결론: 액와-유륜 접근법과 유일-액와 접근을 통한 로봇 내시경적 갑상선 절제술 모두 안전하고 유용한 수술법이다. 로봇 내시경 갑상선 수술에서 유륜의 흉터를 피하고자 하는 경우, 5 mm Maryland dissector 2개를 이용한 유일-액와 접근을 통한 로봇 내시경 갑상선 절제술을 고려해 볼 수 있을 것으로 생각된다.

Keywords

References

  1. Alvarado R, McMullen T, Sidhu SB, Delbridge LW, Sywak MS. "Minimally invasive thyroid surgery for single nodules: an evidence-based review of the lateral mini-incision technique", World J Surg. pp. 1341-48, July, 2008. DOI: http://dx.doi.org/10.1007/s00268-008-9554-4
  2. Miccoli P, Minuto MN, Ugolini C, Pisano R, Fosso A, Berti P. Minimally invasive video-assisted thyroidectomy for benign thyroid disease: an evidence-based review. World J Surg. pp. 1333-40, July, 2008. DOI: http://dx.doi.org/10.1007/s00268-008-9479-y
  3. Kang SW, Jeong JJ, Yun JS, Sung TY, Lee SC, Lee YS, et al. Gasless endoscopic thyroidectomy using trans-axillary approach; surgical outcome of 581 patients. Endocr J. pp. 361-69, No. 3, 2009. DOI: http://dx.doi.org/10.1507/endocrj.K08E-306
  4. Camarillo DB,Krummel TM, Salisbury JK Jr. Robotic technology in surgery: past, present, and future. Am J Surg. pp. 2-15, October. 2004. DOI: http://dx.doi.org/10.1016/j.amjsurg.2004.08.025
  5. Jeong JJ, Kang SW, Yun JS, Sung TY, Lee SC, Lee YS, et al. Comparative study of endoscopic thyroidectomy versus conventional open thyroidectomy in papillary thyroid microcarcinoma (PTMC] patients. J Surg Oncol. pp. 477-80, Aug. 2009. DOI: http://dx.doi.org/10.1002/jso.21367
  6. Lobe TE, Wright SK, Irish MS. Novel uses of surgical robotics in head and neck surgery. J Laparoendosc Adv Surg Tech A. pp. 647-52, December, 2005. DOI: http://dx.doi.org/10.1089/lap.2005.15.647
  7. Moran ME. The da Vinci robot. J Endourol. pp. 986-90, January, 2007.
  8. Kyung Tae, Yong Bae Ji, Jin Hyeok Jeong, Seung Hwan Lee, Mi Ae Jeong, Chul Won Park. Robotic thyroidectomy by a gasless unilateral axillo-breast or axillary approach: our experiences. Surg Endosc. pp. 221-28, January, 2011.
  9. Kyung Tae, MD, Yong Bae Ji, MD, Seok Hyun Cho, MD, Seung Hwan Lee, MD, Dong Sun Kim, MD,Tae Wha Kim, MD. Early surgical outcomes of robotic thyroidectomy by a gasless unilateral axillo-breast or axillary approach for papillary thyroid carcinoma: 2 years' experience. Head Neck. pp. 617-25. May, 2012.
  10. Bodner J, Fish J, Lottersberger AC, Wetscher G, Schmid T. Robotic resection of an ectopic goiter in the mediastinum. Surg Laparosc Endosc Percutan Tech. pp. 249-251, August, 2005. DOI: http://dx.doi.org/10.1097/01.sle.0000174549.87048.f5
  11. Lee J, Yun JH, Nam KH, Choi UJ, Chung WY, Soh EY. Perioperative clinical outcomes after robotic thyroidectomy for thyroid carcinoma: a multicenter study. Surg Endosc. pp. 906-12, March, 2011. DOI: http://dx.doi.org/10.1007/s00464-010-1296-3
  12. Lang BH, Chow MP. A comparison of surgical outcomes between endoscopic and robotically assisted thyroidectomy: the authors' initial experience. Surg Endosc. pp. 1617-23, May. 2011. DOI: http://dx.doi.org/10.1007/s00464-010-1450-y
  13. Kang SW, Jeong JJ, Yun JS, Sung TY, Lee SC, Lee YS, et al. Robot-assisted endoscopic surgery for thyroid cancer: experience with the first 100 patients. Surg Endosc. pp. 2399-2406, November. 2009. DOI: http://dx.doi.org/10.1007/s00464-009-0366-x
  14. Kang SW, Jeong JJ, Nam KH, Chang HS, Chung WY, Park CS. Robot-assisted endoscopic thyroidectomy for thyroid malignancies using a gassless transaxillary approach. J Am Coll Surg. pp. e1-7. August. 2009. DOI: http://dx.doi.org/10.1016/j.jamcollsurg.2009.05.003
  15. Tae K, Ji YB, Jeong JH, Lee SH, Jeong MA, Park CW. Robotic thyroidectomy by a gasless unilateral axillo-breast or axillary approach: our ealy experiences. Surg Endosc. pp. 221-8, January, 2011. DOI: http://dx.doi.org/10.1007/s00464-010-1163-2
  16. Landry CS, Grubbs EG, Morris GS, Turner NS, Holsinger FC, Lee JE, et al. Robot assisted transaxillary surgery (RATS] for the removal of thyroid and parathyroid glands. Surgery, pp. 549-55. April, 2011. DOI: http://dx.doi.org/10.1016/j.surg.2010.08.014
  17. Youben F, BoW, Chunlin Z, Jie K, Bomin G, Fan T, et al. Ttrans-areola single-site endoscopic thyroidectomy: pilot study of 35 cases. Surg Enjdosc, pp. 939-47, April, 2012.
  18. Ikeda Y, Takemi H, Sasaki Y, Tagayama J, Niimi M, Kan S. Clinical benefits in endoscopic thyroidectomy by the axillary approach. J Am Coll Surg. pp. 189-95, February. 2003. DOI: http://dx.doi.org/10.1016/S1072-7515(02)01665-4
  19. Ikeda Y, Takami H, Tajima G, Sasaki Y, Takayama J, Kurihara H, et al. Total endoscopic thyroidectomy: axillary or anterior chest approach. Biomed Pharmacother. pp. 72-78. November, 2002. DOI: http://dx.doi.org/10.1016/S0753-3322(02)00274-3