ROBOTIC THYROID SURGERY

What is robotic thyroid surgery?

It is a robot assisted minimally invasive thyroid surgery . Robotic thyroidectomy is not done by a robot , but your surgeon does it with assistance of robot. This was developed by Korean doctors especially for patients who wants to avoid a scar in the neck.

It involves incison made in the armpit and one incision in the chest(5mm) or in other technique an incision is made behind the ear.Robot has four arms and one camera. Surgeon sitting in the console controls all four arms of the robot and performs the surgery .

Who can have robotic thyroid surgery

Robotic thyroid surgery , as of now is indicated in

  1. Thyroid glands with nodule in one of the lobes
  2. Nodule size less than 2cm
  3. Smaller thyroid glands (<4cm)
  4. Patients who are not obese and
  5. In patients with no evidence of distant spread.

Benefits of robotic thyroidectomy

  1. No scar in the neck as incision is not made in the neck
  2. Robotic arms helps the surgeon to make fine movements with ease and offers better dexterity.
  3. 3D camera offers magnified and better surgical view
  4. which helps in identification of critical structures and preserve them
  5. There by reducing post operative complications
  6. It is less cumbersome when compared to endoscopic thyroidectomy.

Robotic thyroid surgery treatment process

  • Surgical Approach
  • Retroauricular approach(behind ear)
  • Incision is made behind the ear to approach the thyroid gland.
  • This may involve shaving of some hair behind the ear.
  • Position of patient
  • Supine with head turned towards opposite side.

Procedure

Patient is intubated with electromyography endotracheal tube to allow intra operative monitoring of nerve supplying vocal cords. Under general anesthesia,incision is made behind the ear . Flap is raised below the platysma muscle until sternocleidomastoid(SCM) muscle is reached. A surgical plane is created between SCM and strap muscle. Strap muscle are then separated from thyroid gland till the opposite lobe.

A specially designated modified thyroidectomy retractor (Marina Medical, Sunrise, FL, USA) is then secured to the contralateral side of the table mount, and its blade is placed under the flap and strap muscles. This will maintain continuous exposure of the surgical field. The robot, Da Vinci Si or Xi system (Intuitive Surgical, Inc., Sunnyvale, CA, USA), is docked from the contralateral side, using 30-degree dual channel down viewing scope in the center, Maryland dissector in the nondominant hand, and a harmonic curved shears in the dominant hand introduced through the plane created after flap dissection.

Superior thyroid vessels are identified and ligated. Thyroid lobe is mobilised and recurrent laryngeal nerve is identified and preserved. After identification and preservation of parathyroid glands the lobe is excised and delivered out. Cosmetic closure of the wound is done.

Post surgery recovery tips

Recovery from robotic thyroid surgery is similar to recovery from conventional surgery. Patients are usually discharged after 48 hours of observation. Patients are recalled after a week for general check up and removal of sutures if any . Cosmetic closure of wound usually involves sutures placed in the inner side of incision which are resorbable and may not be necessary for removal. Since the incision is made behind the ear the scar is usually hidden.