Gas-insufflation one-step single-port trans-axillary robotic thyroidectomy (GOSTA)

초록

Background To overcome the limitations of conventional trans-axillary (CTA) thyroidectomy, a new surgical approach named as "Gas-insufflation One-step Single-port Trans-Axillary Robotic Thyroidectomy (GOSTA)" was invented. In this study, we introduced this novel approach and compared the CTA approach with the GOSTA approach. Methods A total of 355 patients underwent robotic thyroidectomy in the single tertiary institution, Korea University Ansan Hospital, by a single surgeon named WYC. The CTA thyroidectomy was performed on 211 patients from January 2019 to December 2021, while GOSTA was performed on 141 patients from January 2022 to April 2023, consecutively. In the GOSTA approach, patients were positioned supine with both arms down. The incision required only 3.0 cm. The robot could be docked after creating a one-finger depth flap for the wound retractor, and the skin flap could be created using the robot from the very first stage of the surgery, as a one-step process. The upper pole of the thyroid gland was exposed clearly, allowing for easier preservation of the external branch of the superior recurrent laryngeal nerve, recurrent laryngeal nerve, and other important structures. Additionally, selective lymph node dissection (SND) could be performed as an extension of thyroidectomy without any adoption. For our study, we extracted only the patients who underwent thyroid lobectomy with differentiated thyroid carcinoma, in order to evaluate and perform a comparative analysis. Results There were a total of 167 patients who underwent CTA and 100 patients who underwent GOSTA. The mean age was 49.3 and 48.5 years. There were no significant differences in the total operation time (97.1 and 101.6 minutes). There were 7 postoperative complications in CTA, 4 had transient RLN palsy, and 3 had hematoma that required evacuation. In GOSTA, 1 had transient RLN palsy and the other 1 had hematoma. There were no cases of permanent RLN palsy or chylous drainage in either group. Conclusions The GOSTA procedure represents an innovative progression in the era of robotic thyroidectomy, allowing even for total thyroidectomy with SND through only 3.0cm incision. This technique can be performed feasibly and safely, similar to the conventional trans-axillary approach.