Robotic-assisted Thyroidectomy
‘A new option for thyroid surgery that avoids a tell tale neck scar’
There is a new treatment option available for patients who require thyroid surgery. It represents the latest surgical advance in this area and doesn’t leave a tell tale scar on the neck. This ‘scar-less in the neck’ option promises to expand the boundaries of thyroid surgery by delivering tangible improvements in patient care.
Lead surgeon
Mr Neil Tolley, ENT-Thyroid Consultant Surgeon at St Mary’s Hospital, Imperial College Healthcare NHS Trust pioneered the technique in the UK in 2010 and has the largest clinical experience. His team performed rigorous clinical research to evaluate robotic assisted head & neck surgery over the last 2 1/2 years as part of an ethically approved clinical study. Their work has been reported in The Independent, BBC online and Daily Mail.
Robotic assisted thyroidectomy is a very precise and specific procedure which requires considerable training. Currently, there are only a handful of surgeons in the world qualified to perform this operation. Mr Tolley, a Charter member of the Society of Robotic Surgeons, counts among them.
Development of Robotic-assisted ThyroidectomyRobotic assisted thyroidectomy is a minimally invasive technique to remove all or part of the thyroid and was first developed in the US and South Korea. It is also called robotic thyroid surgery or robot-assisted endoscopic surgery. Before its development, there were 2 main treatment options; conventional open surgery or endoscopic surgery. Open thyroid surgery, also known as standard or conventional open surgery typically leaves a 4-6cm scar in the front of the neck. Endoscopic techniques also involve one or more visible neck scars.
Robotic thyroidectomy eliminates the neck scar by accessing the thyroid gland through an incision under the arm. The scar is usually 6cm long and hidden unlike the neck scars used in conventional and endoscopic thyroidectomy. One of the first studies about robotic thyroidectomy was published in March 2009 so it is a very recent development. More studies are being published now as more doctors report their experience and success with this new technique throughout the world.
Why is it called ‘Robotic’?
This refers to a sophisticated platform called the da Vinci Surgical System which is required to perform robotic-assisted surgery. It is completely controlled by the surgeon who uses it to perform the operation. The system has;
Four arms: These hold tiny instruments which are controlled by the surgeon. They are used to perform the operation and allow the surgeon to make very precise movements.
3D camera: This is a high-definition camera that gives the surgeon a 3D view of the operating field. He or she can zoom in to achieve an even closer view if required.
Console: The surgeon sits at the console, where he or she controls the four robotic hands and sees images from the 3D camera. As the surgeon moves the console controls with his/her hands, state-of-the-art robotic and computer technologies seamlessly translate the surgeon's hand movements into precise movements of the instruments.
Advantages of the system during surgery
Better view: The 3D camera gives a magnified view and enables the surgeon to clearly visualise the thyroid and adjacent structures
Better identification of critical structures: Due to the magnified view, it is easier to identify critical structures, such as the recurrent laryngeal nerve (the nerve that goes to your voice box) and parathyroid glands.
Better dexterity in certain areas: The robotic instruments give the surgeon enhanced dexterity which enables manipulation of certain portions of the thyroid more easily.
Patient advantages
Avoidance of a visible neck scar; the scar is hidden in the armpit which translates to superior cosmetic results. This is the biggest benefit.
Reduced post surgical numbness affecting the front of the neck
Other issues
The complications and recovery time for robotic thyroidectomy are about the same for open or endoscopic surgery. A patient usually spends one day in the hospital following the surgery.
Who Can Have a Robotic Thyroidectomy?
Unfortunately, robotic thyroidectomy isn't a viable treatment option for everyone, but as the technique improves more people may be able to have this surgery. At the moment, the procedure is most suited for patients:
not overweight (BMI<32)
with a small thyroid gland (5cm at the largest)
with nodules confined to just one side of the thyroid gland
with benign (non cancerous) pathology
with no evidence of thyroid inflammation (thyroiditis)
