Robot-assisted transaxillary thyroid surgery in the United States: is it comparable to open thyroid lobectomy?

BACKGROUND: The purpose of this study was to compare the outcome of robot-assisted transaxillary thyroid surgery (RATS) to the standard open technique for thyroid lobectomy in the U.S. population. METHODS: Comparison was made between 25 consecutive patients who underwent thyroid lobectomy via RATS and 25 patients who underwent open thyroid lobectomy. All patients met predetermined criteria for RATS. Clinical characteristics of patients and operative data were compared between groups using the Fisher exact or the Kruskal-Wallis test. RESULTS: The RATS and open groups were similar in gender (92% vs 84% female), median body mass index (BMI) (25 vs 26), preoperative cytology (P=.71), and postoperative diagnosis (P=.91). Operative time for the RATS group was longer than the open group [median 121 minutes (range 74-199 minutes) vs 68 minutes (41-112 minutes), P<.0001]. Estimated blood loss was greater in the RATS group [median 10 cc (0-150 cc) vs 0 cc (0-25 cc), P=.0042]. Unlike the open group, postoperative complications in the RATS group included 2 patients with neurological deficits in the brachial plexus distribution. The postoperative incidence of temporary hoarseness, bleeding, infection, seroma, numbness, and length of hospital stay did not differ significantly between groups. CONCLUSIONS: In a select group of patients, RATS is comparable to open thyroid lobectomy in terms of postoperative complications and hospital stay. Patients should be counseled that RATS is associated with a longer operative time, a potential for brachial plexus neurological deficits, and larger (although still low) blood loss. A prospective trial further evaluating cost, quality of life, and patient-reported satisfaction is warranted.

Hyperglycemia in diabetics and non-diabetics: effect on the risk for and severity of pneumococcal pneumonia.

OBJECTIVES: We sought to determine whether poor glucose control among diabetics is associated with increased risk for pneumococcal pneumonia and whether elevated admitting plasma glucose (APG) levels are associated with increased severity of this infection in diabetic and non-diabetic patients. METHODS: We compared hemoglobin A(1c) (HbA(1c)) in diabetics who had pneumococcal pneumonia with diabetic case-controls who did not have pneumonia. In patients with pneumococcal pneumonia, we related APG to disease severity as determined by SMART-COP score, need for ICU admission, and mortality at 7 and 30 days. RESULTS: Fifty-three of 233 patients with pneumococcal pneumonia (22.7%) were diabetic. Diabetics with pneumonia had poorer glycemic control than diabetic case-controls (HbA(1c) 8.2% vs. 7.2%, respectively, P<0.01). In pneumococcal pneumonia patients, SMART-COP scores, need for ICU admission, and mortality increased in proportion to the APG. These findings were attributable to the significant association between hyperglycemia and severity in non-diabetics. CONCLUSIONS: Poor glycemic control predisposes diabetics to pneumococcal pneumonia but, among diabetics, the degree of hyperglycemia at admission is not associated with increased disease severity. In contrast, among non-diabetics with pneumococcal pneumonia, hyperglycemia is a marker for severe disease and increased mortality, perhaps reflecting massive release of cytokines and glucocorticosteroids in overwhelming infection.