Transoral Robotic Thyroid Surgery Is a Safe Option for Obese Patients

by Amy E. Hamaker •

Is there a difference in surgical outcomes after transoral robotic thyroid (TORT) surgery in obese versus non-obese patients?

Bottom Line: This initial experience shows that TORT appears to be a safe and feasible option for obese patients pursuing scarless thyroid surgery.

Background: Remote-access surgical techniques for thyroid surgery have gained increasing popularity, with TORT eliminating the need for a cervical scar and overcoming endoscopic approach limitations. Several studies have investigated the effect of obesity on open thyroidectomy, but no studies have investigated the effect of BMI on the outcomes of patients who undergo TORT.

Study design: Retrospective cohort study of 304 consecutive patients (290 non-obese, 14 obese) who underwent TORT between January 2012 and December 2017.

Setting: Korea University Medical Center, Seoul, South Korea. 

Synopsis: The mean BMI was 23.05 ± 3.0 for the non-obese group and 33.33 ± 2.9 for the obese group. The majority of all patients underwent right or left lobectomy; unilateral central node dissection was the most common procedure. The mean tumor size was 0.96 ± 0.85 cm for the non-obese group and 1.03 ± 0.96 cm for the obese group. There was no statistically significant difference between groups for the pathology of the thyroid tumor, pT staging, or pN staging for cancer cases. Most cases were early thyroid cancers with pT1a, and pN0 staging was the most common. The majority of cancer cases were papillary carcinoma. Mean operative time was 201.50 ± 37.64 minutes and 222.86 ± 51.73 minutes and mean length of stay was 2.82 ± 1.02 days and 2.79 ± 0.58 days for the non-obese and obese groups, respectively. One patient in each group was found to have oral commissure tearing after the operation that healed uneventfully. All cases that developed general complications belonged to the non-obese group. Limitations included the small number of obese patients; the study’s retrospective, single institution design; and short follow-up time.

Citation: Tai DKC, Kim HY, Park D, et al. Obesity may not affect outcomes of transoral robotic thyroidectomy: subset analysis of 304 patients. Laryngoscope. 2020;130:1343-1348.