Background
Transoral robotic thyroidectomy(TORT) has been popular due to new minimally invasive surgery and invisible scar. Conventional TORT with 4 ports allows fine dissection with counter-traction under optimal view and specimen can be easily removed. However, it needs axillary incision(it is not real scarless thyroidectomy) and wider flap dissection. The purpose of this study is to introduce the early experiences of TORT using 3 ports without axillary incision and compare the results from previous 4 ports.
Material and Method
A total of 80 patients were enrolled in consecutive order; 4 ports group(n=47) is done between December 2016 and July 2017, 3 ports(n=34) is from October 2018 to March 2019. Drain was put in all 4 ports through axillary incision and no drain in 3 ports. The parameters including clinicopathologic data, operation time, postoperative complications(recurrent laryngeal nerve palsy, hypocalcemia, bleeding), postoperative laboratory data(calcium, PTH), hospital stay, and postoperative pain (VAS score) were analyzed.
Results
Operation time(min) was shorter in 3 ports group than 4 ports group(142.0 ± 38.6 vs. 166.3 ± 35.4, p=0.006) and hospital stay(day) was shorter in 3 ports group(2.1 ± 0.3 vs. 3.8 ± 0.4, p=0.001) as well. Postoperative complications(hypocalcemia, nerve palsy, bleeding, seroma and infection), level of calcium(POD#1, 2, 10), PTH(POD#1, 10) and immediate postoperative pain(VAS score) were not different between the groups.
Conclusions
As the surgeon became accustomed to the operation, the operation time was continuously reduced even without the axillary port. Our study showed three ports TORT had a shorter operation time and hospital stay than conventional 4 ports. There were no significant differences between 3 ports and 4 ports TORT in almost postoperative surgical results. In conclusion, TORT using 3 ports is considered to be a comparable, safe and effective operation method as a real scarless operation.