手术机器人凭借其灵活、稳定的操作系统满足了甲状腺手术的精细解剖要求,进而被众多外科医生所接纳。机器人辅助甲状腺手术入路多样可选,能够达到颈部不留瘢痕的美容效果。随着技术的发展,除了常规的根治手术外,机器人辅助甲状腺手术正被逐渐应用于侧颈区淋巴结清扫、毒性弥漫性甲状腺肿等多种复杂病例,且其安全性已获得众多的证据支持。作为现代科技与传统手术结合的产物,未来的机器人手术平台将融合增强现实、人工智能等更多新技术,进一步提升安全性,从而引领甲状腺手术智能化的发展方向。
With advantages of flexibility and stability, robotic surgical system meets the requirements of fine anatomy in thyroid surgery, and has been adopted by numerous surgeons. Surgical approaches of robot-assisted thyroid surgery are various,which could leave no scar on neck and achieve perfect cosmetic results. With the development of technology, in addition to radical thyroidectomy, robotic thyroid surgery is now applied to more and more challenging cases such as lateral neck lymph node dissection and Graves’ disease, and its safety has been proved. As a product combining advanced technology and traditional surgical techniques, robotic surgical system will integrate augmented reality, artificial intelligence and other new technologies in the future, which may further improve its safety and promote the development of intelligent thyroid surgery.
收稿日期:2021-05-06 录用日期:2022-01-22
Received Date: 2021-05-06 Accepted Date: 2022-01-22
基金项目:国家自然科学基金青年项目(81902943)
Foundation Item: National Natural Science Foundation of China (81902943)
通讯作者:严佶祺,Email:yanjiqi@aliyun.com
Corresponding Author: YAN Jiqi, Email: yanjiqi@aliyun.com
引用格式:孙寒星,严佶祺. 机器人辅助甲状腺手术的现状与展望[J]. 机器人外科学杂志(中英文),2023,4(1):18-24.
Citation: SUN H X, YAN J Q. Robot-assisted thyroid surgery: current situation and prospect [J]. Chinese Journal of Robotic
Surgery, 2023, 4(1): 18-24.
[1] Kang S W, Jeong J J, Yun J S, et al. Robot-assisted endoscopic surgery for thyroid cancer: experience with the first 100 patients[J]. Surgical Endoscopy, 2009,23(11): 2399-2406.
[2] 贺青卿, 周鹏, 庄大勇, 等. 经腋窝与胸前径路da Vinci Si 机器人甲状腺腺叶切除二例[J]. 国际外科学杂志, 2014, 41(2): 104-107.
[3] 范林军, 姜军, 马银斌, 等. 达芬奇机器人辅助的腔镜甲状腺瘤切除1 例[J]. 第三军医大学学报, 2014,36(16): 1669, 1673.
[4] 王猛, 郑鲁明, 于芳, 等. 达芬奇机器人手术治疗甲状腺微小癌150 例临床分析[J]. 中国实用外科杂志, 2016, 36(5): 540-542, 546.
[5] 翁原驰, 吴志翀, 陈曦, 等. 机器人经双侧腋窝和乳晕入路甲状腺手术的初步经验( 附40 例报告)[J].外科理论与实践, 2016, 21(6): 517-520.
[6] 中国医师协会外科医师分会甲状腺外科医师委员会, 中国研究型医院学会甲状腺疾病专业委员会.机器人手术系统辅助甲状腺和甲状旁腺手术专家共
识[J]. 中国实用外科杂志, 2016, 36(11): 1165-1170.
[7] Lee S, Ryu H R, Park J H, et al. Excellence in robotic thyroid surgery: a comparative study of robot-assisted versus conventional endoscopic thyroidectomy in papillary thyroid microcarcinoma patients [J]. Ann Surg,2011, 253(6): 1060-1066.
[8] Lee J, Yun J H, Nam K H, et al. The learning curve for robotic thyroidectomy: a multicenter study [J]. Ann Surg Oncol, 2011, 18(1): 226-232.
[9] Yoon J H, Park C H, Chung W Y. Gasless endoscopic thyroidectomy via an axillary approach: experience of 30 cases [J]. Surg Laparo Endo Per, 2006, 16(4):226-231.
[10] Kang S W, Lee S C, Lee S H, et al. Robotic thyroid surgery using a gasless, transaxillary approach and the Da Vinci S system: the operative outcomes of 338 consecutive patients [J]. Surgery, 2009, 146(6):1048-1055.
[11] Ryu H R, Kang S W, Lee S H, et al. Feasibility and safety of a new robotic thyroidectomy through a gasless,transaxillary single-incision approach [J]. J Am CollSurg, 2010, 211(3): e13-19.
[12] Landry C S, Grubbs E G, Morris G S, et al. Robot assisted transaxillary surgery (RATS) for the removal of thyroid and parathyroid glands [J]. Surgery, 2011,149(4): 549-555.
[13] Terris D J, Singer M C, Seybt M W. Robotic facelift thyroidectomy: patient selection and technical considerations [J]. Surg Laparosc Endosc Percutan Tech,2011, 21(4): 237-242.
[14] Duke W S, Holsinger F C, Kandil E, et al. Remote access robotic facelift thyroidectomy: a multiinstitutional experience [J]. World J Surg, 2017, 41(1):116-121.
[15] Richmon J D, Kim H Y. Transoral robotic thyroidectomy (TORT): procedures and outcomes [J]. Gland Surg,2017, 6(3): 285-289.
[16] Berber E, Bernet V, Fahey T J 3rd, et al. American thyroid association statement on remote-access thyroid surgery [J]. Thyroid, 2016, 26(3): 331-337.
[17] YU H W, CHAI Y J, Kim S J, et al. Robotic-assisted modified radical neck dissection using a bilateral axillobreast approach (robotic BABA MRND) for papillary thyroid carcinoma with lateral lymph node metastasis [J].Surg Endosc, 2018, 32(5): 2322-2327.
[18] Paek S H, Lee H A, Kwon H, et al. Comparison of robot-assisted modified radical neck dissection using a bilateral axillary breast approach with a conventional open procedure after propensity score matching [J]. Surg Endosc, 2020, 34(2): 622-627.
[19] HE Q, ZHU J, ZHUANG D, et al. Robotic lateral cervical lymph node dissection via bilateral axillobreast approach for papillary thyroid carcinoma: a single-center experience of 260 cases [J]. J Robot Surg,2020, 14(2): 317-323.
[20] Choi J Y, Kang K H. Robotic modified radical neck dissection with bilateral axillo-breast approach [J].Gland Surg, 2017, 6(3): 243-249.
[21] Garstka M, Kandil E, Saparova L, et al. Surgery for Graves’ disease in the era of robotic-assisted surgery: a study of safety and feasibility in the Western population [J]. Langenbecks Arch Surg, 2018, 403(7): 891-896.
[22] Kwon H, Yi J W, Song R Y, et al. Comparison of bilateral axillo-breast approach robotic thyroidectomy
with open thyroidectomy for Graves’ disease [J]. World J Surg, 2016, 40(3): 498-504.
[23] Kandil E H, Noureldine S I, Yao L, et al. Robotic transaxillary thyroidectomy: an examination of the first one hundred cases [J]. J Am Coll Surg, 2012, 214(4):558-56.
[24] SONG C M, JANG Y I, JI Y B, et al. Factors affecting operative time in robotic thyroidectomy [J]. Head Neck,2018, 40(5): 893-903.
[25] Stang M T, Yip L, Wharry L, et al. Gasless transaxillary endoscopic thyroidectomy with robotic assistance: a high-volume experience in North America [J]. Thyroid,2018, 28(12): 1655-1661.
[26] Kwak H Y, Kim H Y, Lee H Y, et al. Predictive factors for difficult robotic thyroidectomy using the bilateral axillo-breast approach [J]. Head Neck, 2016, 38(Suppl 1):E954-960.
[27] Kim W W, Jung J H, Park H Y. A single surgeon’s experience and surgical outcomes of 300 robotic thyroid surgeries using a bilateral axillo-breast approach [J]. J Surg Oncol, 2015, 111(2): 135-140.
[28] SUN H X, GAO H J, YING X Y, et al. Robotic thyroidectomy via bilateral axillo-breast approach: experience and learning curve through initial 220 cases
[J]. Asian J Surg, 2020, 43(3): 482-487.[29] Kim H, Kwon H, Lim W, et al. Quantitative assessment of the learning curve for robotic thyroid surgery [J]. J Clin Med, 2019, 8(3): 402.
[30] Chen Y H, Kim H Y, Anuwong A, et al. Transoral robotic thyroidectomy versus transoral endoscopic thyroidectomy: a propensity-score-matched analysis of surgical outcomes [J]. Surg Endosc, 2021, 35(11):6179-6189.
[31] Kim M J, Nam K H, Lee S G, et al. Yonsei experience of 5000 gasless transaxillary robotic thyroidectomies [J].World J Surg, 2018, 42(2): 393-401.
[32] Russell J O, Razavi C R, Garstka M E, et al. Remoteaccess thyroidectomy: a multi-institutional north american experience with transaxillary, robotic facelift,and transoral endoscopic vestibular approaches [J]. J Am Coll Surg, 2019, 228(4): 516-522.
[33] Hinson A M, Kandil E, O’Brien S, et al. Trends in robotic thyroid surgery in the United States from 2009 through 2013 [J]. Thyroid, 2015, 25(8): 919-926.
[34] HE Q Q, ZHU J, ZHUANG D Y, et al. Comparative study between robotic total thyroidectomy with central lymph node dissection via bilateral axillo-breast approach and conventional open procedure for papillary thyroid microcarcinoma [J]. Chin Med J (Engl), 2016,
129(18): 2160-2166.
[35] LIU P, ZHANG Y, QI X, et al. Unilateral axilla-bilateral areola approach for thyroidectomy by da vinci robot:500 cases treated by the same surgeon [J]. J Cancer,2019, 10(16): 3851-3859.
[36] Lee S G, Lee J, Kim M J, et al. Long-term oncologic outcome of robotic versus open total thyroidectomy in PTC: a case-matched retrospective study [J]. Surg Endosc, 2016, 30(8): 3474-3479.
[37] Tae K, Song C M, Ji Y B, et al. Oncologic outcomes of robotic thyroidectomy: 5-year experience with propensity score matching [J]. Surg Endosc, 2016,30(11): 4785-4792.
[38] 中国医师协会外科医师分会甲状腺外科医师委员会, 中国研究型医院学会甲状腺疾病专业委员会,中国医疗保健国际交流促进会临床实用技术分会,
等. 机器人甲状腺及甲状旁腺手术中神经电生理监测临床操作专家共识(2019 版)[J]. 中国实用外科杂志, 2019, 39(12): 1248-1253.
[39] Razavi C R, Tanavde V, Shaear M, et al. Simulations and simulators in head and neck endocrine surgery [J].Ann Thyroid, 2020.
DOI: 10.21037/aot.2020.03.03.
[40] Lee D, Kong H J, Kim D, et al. Preliminary study on application of augmented reality visualization in robotic thyroid surgery [J]. Ann Surg Treat Res, 2018, 95(6):297-302.
[41] Muraveika L, Kose E, Berber E. Near-infrared fluorescence in robotic thyroidectomy [J]. Gland Surg,2020, 9(Suppl 2): S147-S152.
[42] 田文. 达芬奇机器人甲状腺切除术的现状与发展[J]. 中华普外科手术学杂志( 电子版), 2020, 14(1):13-16.