published_or_final_versionSpringer Open Choice, 21 Feb 201

BH Lang

Brian Hung-Hin Lang

J Lee

Kai Pun Wong

Man Po Chow

English

PubMed

Wong, KP

Lang, BHH

Chow, MP

HKU Scholars Hub

Title Endoscopic vs robotic thyroidectomy: which is better?Author(s) Lang, BHH; Chow, MP; Wong, KPCitation Annals of Surgical Oncology, 2011, v. 18, suppl. 3, p. S251Issued Date 2011URL http://hdl.handle.net/10722/144920Rights Creative Commons: Attribution 3.0 Hong Kong LicenseLETTER TO THE EDITOREndoscopic vs RoboticThyroidectomy: Which isBetter?TO THE EDITOR:We read with interest the article by Lee et al. 1 and takethis opportunity to congratulate them for their wonderfulwork. The authors compared the perioperative outcomesand learning curves of endoscopic (ET) and robotic thy-roidectomy (RAT) in patients with differentiated thyroidcancer and found that the RAT had shorter total operationtime, greater number of central lymph nodes retrieved, andshorter learning curve than ET. Coincidentally around thesame time, we also reported our initial experience withthese two procedures and compared perioperative out-comes between ET and RAT. However, in contrast to theirfindings, we found that RAT actually took significantlylonger to complete than ET (149 vs. 100 min, P = 0.018),and this remained so even when similar extent of thyroidresection was compared. However, this seemingly contra-dictory finding could be explained by several fundamentaldifferences between the two studies. Firstly, in our series,the majority of the patients had benign thyroid pathologyand therefore did not require a central neck dissection(CND). We agreed that a CND is technically challengingendoscopically, and the availability of three robotic flexibleendo-wrists in RAT certainly makes the procedure easierand shorter to complete. Secondly, Lee et al. had per-formed more than 80 ETs (which based on their ownresults, already well passed their learning curve) prior totheir experience in RAT, whereas in our series, the surgeonwho started RAT had fewer than 10 cases of ET experi-ence. It is conceivable that extensive experience in ETcould shorten the operating time and learning curve inRAT. In fact, to make the two procedures more compara-ble, our study deliberately compared our first seven casesof ET with the first seven cases of RAT, and yet theoperation time was still significantly longer in RAT (120vs. 149 min, P = 0.004).2 In summary, we believe thatunless a CND or a lateral neck dissection is required, for astraightforward hemithyroidectomy or total thyroidectomy,ET shortens the operation time while achieving similarperioperative outcomes. Furthermore, perhaps for surgeonswho are contemplating starting their first few cases ofRAT, it would be valuable to perform ETs initially (i.e.,without the robot) so that they could be familiarized withthe skin flap preparation and the lateral endoscopic view ofthe thyroid gland that are essential in RAT. However, tosupport our view, a future study could evaluate whethersurgeons’ prior experience in ET shortens the learningcurve of RAT when compared with surgeons with noexperience.Brian Hung-HinLang,MS,FRACS, Man Po Chow, MBBS,MRCS, and Kai Pun Wong, MBBS, MRCSDepartment of Surgery, The University of Hong Kong, HongKong SAR, Chinae-mail: blang@hku.hkPublished Online: 10 June 2011 The Author(s) 2011. This article is published with open access atSpringerlink.comOPEN ACCESS This article is distributed under the terms of theCreative Commons Attribution Noncommercial License which per-mits any noncommercial use, distribution, and reproduction in anymedium, provided the original author(s) and source are credited.REFERENCES1. Lee J, Lee JH, Nah KY, Soh EY, Chung WY. Comparison ofendoscopic and robotic thyroidectomy. Ann Surg Oncol. 2011;18:1439–46.2. Lang BH, Chow MP. A comparison of surgical outcomes betweenendoscopic and robotically assisted thyroidectomy: the authors’initial experience. Surg Endosc. 2011;25:1617–23.Ann Surg Oncol (2011) 18:S251DOI 10.1245/s10434-011-1827-8

Annals of Surgical Oncology

Endoscopic vs robotic thyroidectomy: which is better?

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Endoscopic vs Robotic Thyroidectomy: Which is Better?

Brian BrianHung-Hin Lang

Springer

LETTER TO THE EDITOR
Endoscopic vs Robotic
Thyroidectomy: Which is
Better?
TO THE EDITOR:
We read with interest the article by Lee et al. 1 and take
this opportunity to congratulate them for their wonderful
work. The authors compared the perioperative outcomes
and learning curves of endoscopic (ET) and robotic thy-
roidectomy (RAT) in patients with differentiated thyroid
cancer and found that the RAT had shorter total operation
time, greater number of central lymph nodes retrieved, and
shorter learning curve than ET. Coincidentally around the
same time, we also reported our initial experience with
these two procedures and compared perioperative out-
comes between ET and RAT. However, in contrast to their
findings, we found that RAT actually took significantly
longer to complete than ET (149 vs. 100 min, P = 0.018),
and this remained so even when similar extent of thyroid
resection was compared. However, this seemingly contra-
dictory finding could be explained by several fundamental
differences between the two studies. Firstly, in our series,
the majority of the patients had benign thyroid pathology
and therefore did not require a central neck dissection
(CND). We agreed that a CND is technically challenging
endoscopically, and the availability of three robotic flexible
endo-wrists in RAT certainly makes the procedure easier
and shorter to complete. Secondly, Lee et al. had per-
formed more than 80 ETs (which based on their own
results, already well passed their learning curve) prior to
their experience in RAT, whereas in our series, the surgeon
who started RAT had fewer than 10 cases of ET experi-
ence. It is conceivable that extensive experience in ET
could shorten the operating time and learning curve in
RAT. In fact, to make the two procedures more compara-
ble, our study deliberately compared our first seven cases
of ET with the first seven cases of RAT, and yet the
operation time was still significantly longer in RAT (120
vs. 149 min, P = 0.004).2 In summary, we believe that
unless a CND or a lateral neck dissection is required, for a
straightforward hemithyroidectomy or total thyroidectomy,
ET shortens the operation time while achieving similar
perioperative outcomes. Furthermore, perhaps for surgeons
who are contemplating starting their first few cases of
RAT, it would be valuable to perform ETs initially (i.e.,
without the robot) so that they could be familiarized with
the skin flap preparation and the lateral endoscopic view of
the thyroid gland that are essential in RAT. However, to
support our view, a future study could evaluate whether
surgeons’ prior experience in ET shortens the learning
curve of RAT when compared with surgeons with no
experience.
Brian Hung-HinLang,MS,FRACS, Man Po Chow, MBBS,
MRCS, and Kai Pun Wong, MBBS, MRCS
Department of Surgery, The University of Hong Kong, Hong
Kong SAR, China
e-mail: blang@hku.hk
Published Online: 10 June 2011
 The Author(s) 2011. This article is published with open access at
Springerlink.com
OPEN ACCESS This article is distributed under the terms of the
Creative Commons Attribution Noncommercial License which per-
mits any noncommercial use, distribution, and reproduction in any
medium, provided the original author(s) and source are credited.
REFERENCES
1. Lee J, Lee JH, Nah KY, Soh EY, Chung WY. Comparison of
endoscopic and robotic thyroidectomy. Ann Surg Oncol. 2011;18:
1439–46.
2. Lang BH, Chow MP. A comparison of surgical outcomes between
endoscopic and robotically assisted thyroidectomy: the authors’
initial experience. Surg Endosc. 2011;25:1617–23.
Ann Surg Oncol (2011) 18:S251
DOI 10.1245/s10434-011-1827-8


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A comparison of surgical outcomes between endoscopic and robotically assisted thyroidectomy: the authors’ initial experience.

Comparison of endoscopic and robotic thyroidectomy. Ann Surg Oncol.

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Endoscopic vs Robotic Thyroidectomy: Which is Better?

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