Thyroid malignancies are among the top 10 most common cancers in the world: 500,000 people are diagnosed with them every year. Medicine does not stand still and doctors continue to develop more and more advanced treatments for this cancer. One of the newest approaches in this field is robotic surgery.
The da Vinci robot has been used for thyroidectomies since 2007. Since then the technique has become more reliable and improved. It is now an affordable alternative for thousands of thyroid cancer patients.
In this article, we will go into more detail about the pros and cons of this procedure and the specifics of carrying it out abroad.
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What are the advantages of da Vinci surgery compared to open surgery?
The da Vinci robot is a modern medical technology used for minimally invasive surgery. Unlike standard surgery, all procedures are performed using robotic ‘hands’ that are remotely controlled by the surgeon. This approach to surgery can have several advantages for selected patients.
The first and foremost advantage of da Vinci technology is better cosmetic results. While standard thyroidectomy leaves behind a noticeable scar on the neck, with robotic surgery there is no such problem. Incisions are made under the arm, near the ear canal or inside the oral cavity – places where the scar is easy to hide.
A second advantage associated with the da Vinci robot is better visualisation and range of motion, even in comparison with laparoscopic surgery – one of the more widely used variants of this procedure. It involves the doctor inserting surgical instruments inside the patient to avoid having to make large incisions. It, like the robotic procedure, avoids large scars, but at the cost of a smaller range of motion for the surgeon. Meanwhile, the da Vinci robot’s instruments can rotate around their axis by 360° – making them more mobile than the human hand – and allow a good view of the operated area (generating a 3D image with 10x magnification).
In addition, modern models of the da Vinci robot can perform fluorescence diagnostics during surgery. This allows good visibility of the nerve tissue, which in turn reduces the risk of nerve damage.
The da Vinci robot can also be used to resect tumours extensively, cutting them out in one piece. This differs from some other techniques that involve crushing the tumour into smaller pieces before removing them.
Da Vinci robot also has a hand tremor elimination function, which eliminates the risk of human error, thereby increasing the safety of the operation.
On top of this, the technology reduces blood loss and the time needed to recover from surgery.
DA VINCI SURGERY APPOINTMENT
Thyroid treatment with the da Vinci robot is available abroad. If you are interested in this procedure, please leave a request online and our coordinating physicians will call you back to advise you on the procedure and organise your treatment.
Thyroid disease treatment using the da Vinci robot
Robotic surgery in the treatment of thyroid diseases is considered an exclusive method. These operations are more complex than open procedures. They require experience and precision on the part of the surgeon. There are not many doctors worldwide who specialise in this procedure.
There are three different approaches to robotic thyroidectomy in current practice: transaxillary, retroauricular and transoral. Each has advantages and disadvantages. The choice of method depends on the characteristics of the disease and the experience of the surgeon.
In addition, the treatment of thyroid tumours differs according to the degree of resection. Depending on the stage of the disease, the surgeon may remove the organ completely or only half of it. It is also possible to cut out neighbouring lymph nodes during the procedure if cancer cells have also been detected there.
The transaxillary approach
This is the most common method of carrying out the robotic removal of a thyroid tumour. The doctor gains access through a small incision made under the arm.
The advantages of this operation to remove a thyroid tumour include:
Effectiveness and safety;
The lowest risk of swallowing problems compared to all methods;
Possibility of resection in an advanced stage of cancer;
Low risk of damage to the recurrent laryngeal nerve.
The main disadvantage of this method is the possible risk of developing anterior thoracic paresthesia, which is manifested by a burning and tingling sensation. In most cases this is temporary, but in some patients, it can persist permanently. Damage to the brachial plexus is also among the possible postoperative complications.
Retroauricular approach
The surgeon makes an incision along the posterior auricle, running above the mastoid process and below, parallel to the occipital hairline. This provides access to the thyroid gland.
The advantages of the approach are:
Significantly less tissue dissection, making post-operative recovery easier and shorter;
Ability to operate on obese patients;
No risk of damage to the large vessels, oesophagus and sensory nerves in the anterior thorax.
The risks of the retroauricular approach include damage to the greater auricular and marginal mandibular nerves. In most cases, the symptoms go away on their own within a few months after surgery.
A transoral approach
This is the newest method of performing thyroid cancer surgery using the da Vinci robot. Because of this, it is the most rarely used. With the transoral approach, there is absolutely no scarring on the surface of the patient’s body, as the surgeon accesses the tumour through the mouth. Three incisions are made on the inside of the lower lip: one in the midline, about 2 cm above the frenulum, and two near the corners of the mouth.
This surgical approach gives the surgeon very good access to the thyroid gland, making it the safest way to perform a total thyroidectomy. Hospital reports also indicate that the number of postoperative complications is lowest with this approach. In addition, the transoral method offers the fastest scar healing, taking an average of 2-3 weeks to heal.
The main disadvantage of this method is the need to take antibiotics for a longer period to avoid infection, and hence a longer hospital stay.
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Indications and contraindications for surgery
The da Vinci robot is used in the treatment of such diseases:
Papillary carcinoma of the thyroid gland;
Follicular tumours of the thyroid gland;
Benign thyroid cyst;
Uninodular goitre;
Multinodular goitre.
The selection of patients for whom robotic treatment of a thyroid tumour may be indicated is an important aspect. Together with the professionalism of the surgeon, this significantly affects the outcome of the operation. It is therefore important to remember that surgery with the da Vinci robot will be suitable for approximately 25% of patients. When a patient is referred to a clinic that specialises in robotic surgery, a medical board will review the diagnostic results and recommend the best treatment plan based on them.
The official recommendations for the use of da Vinci technology in thyroidectomy have been established by the American Thyroid Association:
Tumour size no larger than 3 cm with no signs of extensive lymph node metastasis on preoperative ultrasound;
Benign nodule up to 6 cm;
Thyroid size up to 5-6 cm;
No thyroiditis;
Good neck and arm mobility;
No history of trauma or irradiation of the neck;
The patient’s weight is within healthy limits.
There are also circumstances in which surgery will be strictly contraindicated:
General anaesthesia intolerance;
Poorly differentiated thyroid cancer;
Locally advanced thyroid cancer with invasion of the trachea or oesophagus;
Graves’ disease;
Cervical or retropharyngeal lymph node involvement;
Parathyroid lesions;
Past neck surgery;
Past neck radiotherapy;
Oral abscesses.
BOOK A CONSULTATION WITH AN ONCOLOGIST
For thyroid cancer treatment following the latest protocols, contact the international platform MediGlobus. We will help you find a clinic and doctor based on your criteria.
Treatment prognosis
The experience of Korean surgeons shows that the treatment of thyroid cancer is one of the most promising in the field of robotic surgery.
The prognosis for the treatment of thyroid tumours using the da Vinci robot is very positive. This surgery has a number of both objective and subjective advantages over open surgery.
Safety: 99-99.2% of operations are performed without serious complications;
Efficiency: better in removing diseased lymph nodes;
Ergonomics: more opportunity for complete surgical resection due to a better range of motion and visualisation;
Postoperative period: no scar on the neck, less pain and discomfort.
When robotic surgery is considered in the treatment of thyroid cancer, the overall prognosis depends on the stage of the disease and the type of tumour:
| Localised cancer | Regional metastases | |
|---|---|---|
| Papillary thyroid cancer | 99% | 99% |
| Follicular thyroid cancer | 99% | 98% |
| Medullary thyroid cancer | 99% | 90% |
| Anaplastic thyroid cancer | 34% | 9% |
Where abroad is thyroid surgery performed with the da Vinci robot?
Among European countries, the University Hospital of Navarra (Spain) is considered to be the best clinic for thyroid cancer treatment. It is a pioneer in the region in this field and has one of the strongest robotic surgery departments in the region.
The Da Vinci technique has been used at this centre since 2010. The clinic is staffed by experienced surgeons, one of the best known of whom is Professor Juan Manuel Alcalde. He has over 30 years of professional experience.
How much does minimally invasive thyroid surgery cost?
| Country | Cost |
|---|---|
 Spain | €10,000-13,000 |
Resume
Da Vinci surgery is applicable in some cases of thyroid disease, including cancer.
The advantages of robotic surgery compared to open surgery: no large scar on the neck, greater surgical range, more extensive resection, less risk of side effects and postoperative complications, less blood loss, shorter and easier recovery.
The operation can be carried out in three different ways: through the armpit, through the space behind the auricle or the oral cavity.
The effectiveness of treatment for thyroid disease depends on the stage and in most cases exceeds 90%.
Among the European clinics for thyroid cancer treatment, we can recommend the University Centre of Navarra. Surgery using the da Vinci robot will cost between €10,000 and €13,000.
SING UP FOR THE DA VINCI SURGERY
To make an appointment for this procedure abroad, click on the button below and fill in the form. Our coordinators will call you back within 30 minutes. They will provide all the necessary information and help with travel arrangements.
Resume:
- 1. Gland Surgery: Overview of robotic thyroidectomy
- 2. Journal of Minimally Invasive Surgery: Transoral Robotic Thyroidectomy: The Overview and Suggestions for Future Research in New Minimally Invasive Thyroid Surgery
- 3. Asian Journal of Surgery: Trends of robotic-assisted surgery for thyroid, colorectal, stomach and hepatopancreaticobiliary cancer
- 4. European Thyroid Journal: Robotic Surgery for Thyroid Disease
- 5. American Cancer Society
