Three-Port Transoral Robotic Thyroidectomy in Papillary Thyroid Carcinoma

Summary: Background: Transoral thyroidectomy has advantages in cosmesis and postoperative voice outcomes compared to conventional thyroidectomy. However, it has a steep learning curve and longer operative time. This study aimed to assess the learning curve and factors affecting operative time in transoral robotic thyroidectomy (TORT). Methods: A retrospective study was conducted on 173 consecutive patients who underwent TORT with or without central neck dissection from July 2017 to August 2021. The TORT learning curve was evaluated using operative time, complication rate, and surgical success rate. The cumulative summation (CUSUM) method was employed to calculate the learning curves for operative time and surgical success rate. Factors influencing operative time in TORT were also analyzed. Results: The operative time for total thyroidectomy was significantly longer than that for lobectomy and isthmusectomy (p < 0.001). A positive correlation between body mass index (BMI) and operative time was found (R-2 = 0.04, p = 0.025). The CUSUM analysis showed that the learning curve for TORT was around 52 cases for operative time and 55 cases for surgical success rate. Complication and procedure conversion rates significantly decreased after reaching the learning curve. Conclusions: The learning curve for TORT was approximately 52-55 cases, and operative time, complication rate, and procedure conversion rate decreased significantly after reaching the learning curve. Operative time was associated with the extent of thyroidectomy and BMI.

Summary: Transoral endoscopic modified radical neck dissection of levels 2, 3, and 4 can be feasible and safe for highly selected patients.

Summary: The study compared the safety and outcomes of transoral robotic thyroidectomy (TORT) with transoral endoscopic thyroidectomy vestibular approach (TOETVA), finding that TORT requires a longer operative time but is as safe as TOETVA and may be useful for more complex thyroid operations.