机器人甲状腺手术的发展现状和思考

Recent advances and considerations about robotic thyroidectomy

机器人甲状腺手术整合了机器人系统和腔镜甲状腺手术的优点，可提供卓越的三维高清显示效果、稳定的手术视野和精细灵活的操作，经过临床10年的广泛应用，证实具有和开放手术同样的手术安全性和肿瘤根治性，并为患者提供更好的手术微创（心理和生理微创）、功能保护（颈部功能、甲状旁腺和喉返神经保护）和外形美观的手术效果。手术入路主要是双侧腋窝乳晕入路和腋窝入路。目前手术适应证已扩展至直径2～4cm间的甲状腺癌及伴有侧区淋巴结转移的患者。相关研究主要是回顾性或对照性研究，亟待开展多中心随机对照研究和长期随访，为机器人甲状腺手术的进一步推广提供高级别的研究证据。

Robotic thyroidectomy （RT） system combines the advantages of the surgical robot and remote access thyroidectomy, provides the benefits of excellent three-dimensional visualization, stable operative view and improved surgical dexterity, has been applied in clinical practices for 10 years and proved to have comparable surgical safety and oncological completeness with traditional open operation, and provides smaller surgical injury （psychological and physical injury）, better functional protection （including neck function, parathyroid glands and laryngeal nerve）, and significantly higher cosmetic satisfaction. There are two mostly common used RT approach- es, bilateral axillobreast approach （BABA） and tran^axillary approach （TAA）. Since surgeons accumulate more experience, the indications of RT have been expanded to differentiated thyroid cancer with tumor size between 2- 4 cm with （or without） lateral neck lymph node metastases by far. To date, all related studies are nonrandomized or retrospective comparisons. It＇s necessary to launch multi-centers randomized studies and long term follow-up to offer higher evidence to boost the future application of RT.