Surgery

Biography

Biography: Robert Caiazzo

Abstract

Introduction: Th e trans-axillary thyroid surgery robot assisted, developed in South Korea, is an alternative to cervicotomy with great cosmotic benefi t. Its distribution in Europe and US remains limited to a few centers experts, mainly because of its technical difficulty. Most studies are Asian with sometimes confl icting results and no multicenter European study was available. Aim: Our aim was to evaluate the functional results, aesthetic and oncological and identify the specifi c complications of transaxillary robot assisted thyroid surgery. Materials & Methods: Retrospective multicenter study of patients undergoing partial or total thyroidectomy in Lille, Nancy and Geneva with a postoperative follow-up of at least 6 months. Pre- and intraoperative data were extracted from medical records and follow-up data were collected by contacting every patient by phone. Results: 98 interventions were carried out from January 2010 to August 2014, in 93 consecutive patients: 47 lobectomies including 5 totalization of thyroidectomy and 51 total thyroidectomy for suspected thyroid nodules in 69 pateints, 15 toxic nodules or goiter, 8 symptomatic goiter and Graves' disease in 6 patients. Th e operating averaging times were 175±57 minutes for lobectomies and 195±39 minutes for total thyroidectomy. Th e patients evaluated the quality of scar as 7.5 / 10. Th ere was no serious complication, there was 9.2% recurrent paralysis including one defi nitif and 10.2% of hypocalcemia including 1 persistant hypocalcemia. Postoperative pain was moderate with EVA score of less than 4/10 in 58.2% (n=57) and controlled by level I and II of analgesics allowing one day surgery for 4 patients. At 6 months, the rate of mechanical pain was 6.1% (n=6), the rate of cervical adhesions was 19.4% (n=19) and the rate of pre-pectoral dysesthesia was 51% (n=50). Th ese dysesthesia were associated with functional impairment and neuropathic pain in 5.1% (n=5) of patients, necessitating specialized consultation. Th ese symptoms have improved under short treatment by gabapentin and motor physical therapy. Patients whose pathology revealed the presence of cancer, had a mean of follow-up of 25±11 months. Th e patients who received their complementary therapy-I 131, the thyroglobulins were below 1 ng / ml (0.1±0.3 [0 to 0.4]) and all scans of revaluation with 5mCi were normal except two showing an ordinary fi xation without corresponding thyroid ultrasound residue. Conclusion: Th is study shows the results of the trans-axillary thyroid surgery in its learning curve for European patients. Th is approach allows the absence of cervical scar but it is associated with specifi c complications related to subcutaneous dissection path.