The pros and cons of additional axillary arm for transoral robotic thyroidectomy

Background:Transoral vestibular approach thyroidectomy using robotic system has advantages with articulating instrumentation.Transoral robotic thyroidectomy(TORT)can be done either using just two robot arms for instruments and an extra one for the endoscopic camera,or using three robot arms for instruments(third arm through axila)and an additional arm for the camera.Pros of additional axillary arm for TORT:The 4th arm through an additional axillary port is mainly responsible for a counter-traction of strap muscles and thyroid tissue.The additional axillary port tract is also an excellent passage for the specimen removal with lower risk of disruption or fragmentation.Ultimately,these merits from the additional axillary arm allows TORT to be performed safely in a wide range of patient groups.Cons of additional axillary arm for TORT:One of the issue with the additional axillary arm in TORT is that it leaves a cutaneous scar.Another issue to consider is the cost.In some places,robotic surgery operation fee varies with the number of arms used during the operation.Retraction of strap muscles through subcutaneous stitches applied after establishing the working space may make up for the lack of counter-traction.Conclusion:TORT can be done safely with or without the transaxillary arm and surgeon may consider pros and cons based on multiple factors.

小切口腔镜辅助甲状腺切除术与传统开放手术治疗甲状腺癌的疗效观察

目的探讨小切口腔镜辅助甲状腺切除术与传统开放手术治疗甲状腺癌的疗效比较。方法选取2016年3月至2020年3月间西安市中心医院收治的70例甲状腺癌患者,采用随机抽签法分为观察组和对照组,每组35例。观察组患者采用小切口腔镜辅助甲状腺切除术治疗,对照组患者采用传统开放手术治疗,比较两组患者手术指标、并发症及声音恢复效果。结果两组患者手术时间比较,差异无统计学意义(P>0.05)。观察组患者术中出血量、切口长度、术后引流量、术后颈部恢复活动时间、拆线时间、疼痛缓解时间和住院时间均优于对照组,差异均有统计学意义(均P<0.05)。观察组患者并发症发生率为5.7%,低于对照组的25.7%,差异有统计学意义(P<0.05)。术前及术后1d,两组患者声音障碍程度评分比较,差异无统计学意义(P>0.05)。出院时及出院3个月,观察组患者声音障碍程度评分均低于对照组,差异均有统计学意义(均P<0.05)。结论甲状腺癌采用小切口腔镜辅助甲状腺切除术治疗,可缩短住院时间,减少术后并发症,且术后无明显声音障碍,手术效果好,值得推广应用。