Help or Hoopla?: Surgical robots can benefit otolaryngology

Robotic Thyroidectomy

Woon Youn Chung, MD, of Yonsei University College of Medicine in Seoul, developed a technique to remove the thyroid via the axilla, eliminating the need for a surgical incision on the neck. The technique has since been adopted and refined by North American surgeons, including Ron Kuppersmith, MD, FACS, a clinical faculty member of the Texas A&M Health Science Center and an otolaryngologist with Texas ENT and Allergy.

“Any time the public hears the word ‘robot,’ they get excited,” Dr. Kuppersmith said. “As physicians, we need to temper that enthusiasm and be realistic. Only 10 to 20 percent of the patients that I see are candidates for robotic surgery.”

The best candidates are healthy, highly motivated individuals who do not want a visible surgical scar. Dr. Kuppersmith is happy to offer robotic thyroidectomy as an option for these patients, even though robotic surgery “is probably more work and is basically reimbursed the same as a traditional thyroidectomy,” he said.

During the procedure, the robotic arms are used to tunnel from the axilla to the thyroid. Operating times are typically longer than an open thyroidectomy; reported times range from 1.8 hours to just under 2.5 hours (Surgery. 2009;146(6):1048-1055; Laryngoscope. 2011;121(3):521-526). Complications include transient vocal cord paresis and one patient’s inability to extend her fingers on the operative side, a complication that resolved by one month and that Dr. Kuppersmith believes was related to positioning (Laryngoscope. 2010;121(3)521-526). “We’ve since modified the arm positioning. It’s never happened again,” he said. Approaching the thyroid via the axilla also increases the risk of esophageal perforation, brachial plexus injury and carotid or jugular vein injury, according to another study (Thyroid. 2010;20(12):1327-1332).

According to Dr. Magnuson, the benefit of robotic thyroid removal is mostly cosmetic. Unlike TORS surgery, “[patients who undergo robotic thyroidectomy] don’t have a short hospitalization. They don’t have a quicker recovery.” Dr. Kuppersmith added, “This procedure is clearly not going to supplant or replace traditional thyroid surgery.”

TORS for Sleep Apnea

Internationally, surgeons are beginning to use TORS as a treatment for obstructive sleep apnea as well. Italian surgeon Claudio Vicini, MD, was the first use to TORS to manage tongue base hypertrophy (J Otorhinolaryngol Relat Spec. 2010;72(1):22-27; Head and Neck. Published online ahead of print, March 11, 2011.)