Health-related quality of life after transoral robotic thyroidectomy in papillary thyroid carcinoma.

BACKGROUND: Health-related quality of life after transoral robotic thyroidectomy has not been evaluated thoroughly. The purpose of this study was to compare health-related quality of life after transoral robotic thyroidectomy and after conventional thyroidectomy. METHODS: This study is a prospective, cross-sectional, and observational study of 114 patients who underwent transoral robotic thyroidectomy (57 patients) or conventional transcervical thyroidectomy (57 patients) for the treatment of papillary carcinoma. We used 2 questionnaires: the University of Washington Quality of Life questionnaire for head and neck cancer and the thyroid cancer-specific Quality of Life questionnaire (Thyroid Version). The survey was performed preoperatively, and 3 months and 1 year after thyroidectomy. RESULTS: Mean scores for neck appearance were higher after surgery in the transoral robotic thyroidectomy group than the conventional group at both 3 months and 1 year. Anxiety was significantly improved after surgery in both groups. Total scores for health-related quality of life after surgery were similar in both groups. Health-related quality of life and overall quality of life over the previous 7 days as measured by the University of Washington Quality of Life questionnaire were significantly better at 1 year than in the preoperative period in both groups. Before surgery, patients in the both groups regarded anxiety and mood as the most important aspects of health-related quality of life. After surgery, patients in the transoral robotic thyroidectomy group identified anxiety, mood, and speech as the most significant issues, while patients in the conventional group selected anxiety, mood, and neck appearance. CONCLUSION: Quality of life related to neck appearance is higher after transoral robotic thyroidectomy than after transcervical thyroidectomy. However, total scores for health-related quality of life did not differ in the 2 groups after surgery.

Cosmetic outcomes after transoral robotic thyroidectomy: Comparison with transaxillary, postauricular, and conventional approaches.

OBJECTIVES: Transoral thyroidectomy does not involve neck incision, and its postoperative cosmetic outcome is thought to be superior to that of conventional thyroidectomy and other remote-access procedures. This study aimed to compare the cosmetic outcomes between transoral robotic thyroidectomy (TORT) and conventional transcervical thyroidectomy and two common remote-access robotic thyroidectomies via the transaxillary and postauricular approaches. MATERIALS AND METHODS: We analyzed 160 patients who underwent TORT, robotic thyroidectomies via the transaxillary or postauricular approach, or conventional transcervical thyroidectomy (40 patients in each group). The postoperative cosmetic outcomes, including cosmetic satisfaction and scar consciousness scores, were evaluated using self-assessment cosmesis questionnaires at 3 months and 1 year postoperatively. The cosmesis index was defined as the sum of the percentage scores for cosmetic satisfaction and scar consciousness. RESULTS: Cosmetic satisfaction scores, scar consciousness scores, and cosmesis indexes were significantly higher for the transoral, transaxillary, and postauricular approaches than the conventional approach at 3 months and 1 year postoperatively. There was a trend of better cosmetic outcomes, especially regarding scar consciousness, for the transoral and transaxillary approaches than for the postauricular approach, but the difference was not statistically significant. CONCLUSION: Postoperative cosmesis of TORT, as well as the transaxillary and postauricular approaches, is superior to that of conventional thyroidectomy. The cosmetic outcomes of the transoral and transaxillary approaches seem to be better than those of the postauricular approach.

Sensory change in the chin and neck after transoral thyroidectomy: Prospective study of mental nerve injury.

BACKGROUND: The study aimed to evaluate the sensory changes on the chin and neck in transoral thyroidectomy. METHODS: We prospectively assessed the cutaneous sensation of 10 zones of the chin, face, and neck in 43 patients who underwent transoral robotic or endoscopic thyroidectomy using the Semmes-Weinstein monofilaments test, preoperatively and postoperatively at 1 week, 1 month, and 3 months. RESULTS: The sensation of the chin and lower lip did not differ before and after surgery. However, the pressure threshold of the submental and level VI area increased significantly after surgery, and returned to the preoperative level 1 month and 3 months postoperatively, respectively. CONCLUSION: In terms of mental nerve injury, transoral thyroidectomy is safe when performed successfully. However, proper placement of oral vestibular incisions and minimal dissection of the chin is essential to avoid mental nerve injury.

Functional and cosmetic outcomes of robot-assisted neck dissection by a postauricular facelift approach for head and neck cancer.

OBJECTIVES: The purpose of this study was to compare the functional and cosmetic outcomes of robot-assisted neck dissection with those of conventional neck dissection. MATERIALS AND METHODS: We prospectively analyzed 113 patients with head and neck cancer who underwent unilateral neck dissection by a robot-assisted postauricular facelift approach (38 patients) or conventional trans-cervical approach (75 patients). Postoperative functional outcomes such as edema, sensory loss, pain, and fibrosis in the neck, and limitations of neck and shoulder motion, and cosmetic satisfaction scored by questionnaire were evaluated serially up to 1year postoperatively, and compared between the two groups. RESULTS: There were differences at baseline clinicopathologic characteristics including age, T classification and stage between the two groups. The mean score of neck edema was lower in the robotic group than that of the conventional group at 1day and 3days postoperatively, and sensory loss was also lower in the robotic group at 1day, 3days and 1week postoperatively (P<0.05). The postoperative cosmetic satisfaction were significantly higher in the robotic group than the conventional group at 1month, 3, 6, and 12months postoperatively. Transient marginal nerve palsy was higher in the robotic group than the conventional group (P=0.043). CONCLUSION: Postoperative neck edema and sensory loss were lower in the robotic group in the early postoperative period although its clinical significance is not clear. Cosmetic satisfaction was superior in the robotic group.

Postoperative Pain After Robotic Thyroidectomy by a Gasless Unilateral Axillo-Breast or Axillary Approach.

The aim of this study was to compare postoperative pain after robotic thyroidectomy with that after conventional open thyroidectomy. We analyzed 123 patients who underwent robotic thyroidectomy and 170 patients who underwent conventional open thyroidectomy. Postoperative pain was evaluated on a visual analogue scale rating of 0 to 10, 1 day to 1 month after surgery. Mean pain visual analogue scale scores for the robotic and open groups were 3.33 and 3.57 (P=0.476) on day 1, 2.29 and 2.58 (P=0.285) on day 3, 2.19 and 1.74 (P=0.057) after 1 week, and 0.98 and 1.01 (P=0.843) after 1 month, respectively. There was no difference between the 2 groups in the doses of parenteral analgesic medication administered (robotic vs. open, mean 174 vs. 194 mg, P=0.189). In conclusion, postoperative pain and the dose of analgesic medication in both groups are similar.

Quality of life after robotic thyroidectomy by a gasless unilateral axillary approach.

BACKGROUND: Robotic thyroidectomies have been safely performed with early surgical outcomes comparable to conventional cervical thyroidectomies. However, health-related quality of life (HRQOL) after robotic thyroidectomy has not yet been evaluated. The aim of this study was to compare HRQOL of patients who underwent robotic thyroidectomy with that of those who received conventional thyroidectomy. METHODS: We conducted a cross-sectional study in 111 patients who underwent either robotic thyroidectomy (44 patients) via a gasless unilateral axillary approach, or conventional cervical thyroidectomy (67 patients), for papillary thyroid carcinoma (PTC). HRQOL of patients was assessed using two questionnaires, the University of Washington Quality of Life (UW-QOL) questionnaire for patients with head and neck cancer, and the Quality of Life-Thyroid Version (QOL-TV), which was specifically designed for thyroid cancer patients. The survey using the questionnaires was performed 1 year after surgery at a routine outpatient clinic follow-up. RESULTS: There was no difference in UW-QOL scores between the two groups for any factor other than neck appearance and physical composite score, which were higher in the robotic group. Humor (mood) and anxiety, emotional measures of UW-QOL, were selected by patients in both groups as being their most significant issue during the preceding 7 days. There was no between-group difference in the four QOL-TV domains (physical, psychological, social, and spiritual well-being). CONCLUSIONS: Patients who underwent robotic thyroidectomy reported a higher score for satisfaction with neck appearance compared to patients receiving conventional cervical thyroidectomy. However, the overall HRQOL of patients in the robotic and conventional groups was similar.

Long-term cosmetic outcomes after robotic/endoscopic thyroidectomy by a gasless unilateral axillo-breast or axillary approach.

BACKGROUND: Although the excellent short-term cosmesis after robotic/endoscopic thyroidectomy has been reported, the long-term cosmetic outcome is not yet known. The aim of this study was to evaluate the long-term cosmetic outcome of robotic/endoscopic thyroidectomy. PATIENTS AND METHODS: We compared 147 patients who underwent robotic or endoscopic thyroidectomy using a gasless unilateral axillo-breast (GUAB) approach or a gasless unilateral axillary (GUA) approach with 161 conventional open thyroidectomy patients. Subjective cosmetic outcomes were evaluated using a series of scar-specific questions as well as the Vancouver scar scale at 12-18 months after surgery. The cosmetic satisfaction score was defined as the sum of the two cosmetic satisfaction questions with a rating scale of 1-5. The scar consciousness score was defined as the sum of the four scar consciousness questions with a rating scale of 0-3. RESULTS: The cosmetic satisfaction and scar consciousness scores were significantly better in the robotic/endoscopic group than in the open group (P<.001 in both). The cosmetic satisfaction and scar consciousness scores were the same in the robotic and endoscopic groups and were also the same in the GUA and GUAB approach groups. Patients treated by the GUA approach were more satisfied with their scarless breasts than patients treated by the GUAB approach having breast scars. CONCLUSIONS: Long-term postoperative cosmesis after robotic/endoscopic thyroidectomy using GUAB/GUA approaches is significantly better than conventional open thyroidectomy. In the robotic/endoscopic group, the scarless breasts resulting from the GUA approach lead to greater satisfaction than those after the GUAB approach.

Long-term sensory disturbance and discomfort after robotic thyroidectomy.

BACKGROUND: The aim of this study was to compare short-term and long-term sensory disturbance and discomfort after robotic thyroidectomy versus conventional open thyroidectomy. METHODS: We compared 118 patients who underwent robotic thyroidectomy by a gasless unilateral axillobreast (GUAB) or axillary (GUA) approach with 176 patients who underwent conventional open thyroidectomy from April 2009 to June 2011. Postoperative hypesthesia/paresthesia and discomfort of the neck and anterior chest were evaluated regularly for 1.5 years using a questionnaire with a scale from 0 to 4. RESULTS: There were no differences in neck discomfort or hypesthesia/paresthesia between the two groups. Neck discomfort and hypesthesia/paresthesia returned to preoperative levels by postoperative years 1.0 and 1.5, respectively, in both groups. Anterior chest discomfort and paresthesia/hypesthesia were higher in the robotic group than the open group. They returned to preoperative levels by postoperative year 1 in the robotic group and within 3 months in the open group. CONCLUSIONS: Long-term sensory disturbance and discomfort of the neck does not differ between robotic thyroidectomy and conventional open thyroidectomy. However, anterior chest discomfort and sensory disturbance are greater and require longer times to recover after robotic thyroidectomy. Minimizing dissection of the anterior chest should be considered to reduce discomfort and sensory disturbance after robotic thyroidectomy by a GUAB/GUA approach.