Robotic Thyroidectomy

What is a robotic thyroidectomy?

Robotic thyroidectomy, also known as robotic thyroid surgery, is a minimally invasive procedure that involves removing a part of or the entire thyroid gland with the help of a robot-assisted surgical system.

How it works

Unlike conventional open surgery which needs a larger cut in the neck to reach the thyroid gland, this robotic procedure only involves making either a larger cut or a few keyhole cuts in the armpit instead.

The robot-assisted surgical system makes full use of the tight surgical space provided by a small cut by utilising its 4 articulated robotic arms and a high-performance vision system. This allows the surgeon to operate with accuracy and dexterity while aided by magnified images of the interior of the body.

Why do you need a robotic thyroidectomy?

Thyroidectomy is the recommended treatment for several thyroid conditions, such as:

• Thyroid cancer and benign nodules
• Goitres (swollen thyroid gland)
• Hyperthyroidism (overactive thyroid)

Benefits of robotic assisted thyroidectomy

With a robotic thyroidectomy, there will be no scars on your neck.

Some studies also show:

• Reduced chances of laryngeal (voicebox) nerve damage
• Reduced risk of affected parathyroid gland (small hormone glands in your neck that control calcium levels in your bones and blood)

Who should not undergo robotic thyroidectomy?

Robotic thyroidectomy works best for patients who have:

• Nodules up to 6cm
• Cancers that are not widely invasive
• Goitres that are not too large

Your surgeon would need to evaluate your thyroid before determining if you are a good candidate for robotic thyroidectomy.

What are the risks and complications of robotic thyroidectomy?

Any surgery carries with it the potential for complications. Because minimally invasive surgery uses smaller incisions, patients generally recover faster than with traditional surgery. However, there is still the risk of complications resulting from anaesthesia, bleeding and infection.

The risks of thyroidectomy, whether open or robotic, are:

• Nerve injury causing hoarseness of voice
• Temporary or permanent drop in blood calcium level

The specific risks of a robotic thyroidectomy include:

• Gas trapped beneath the skin (temporary)
• A lengthier surgery
• Numbness of skin below collarbone
• Arm or hand weakness due to positioning (temporary and rare)
• Switching to open surgery due to unexpected difficulty (rare)
• Device malfunction or failure

How do you prepare for a thyroidectomy?

Your doctor will provide you instructions to follow before and after surgery. This includes when and what medications to stop taking.

You may need to make arrangements for assistance after the surgery, such as arranging transport home, at-home care and other tasks of daily living.

As you will be staying at the hospital overnight, do pack a bag of essentials such as personal toiletries and other personal items you may need.

Do dress comfortably on the day of your surgery and bring the necessary documents (e.g. identification) for your hospital stay.

What can you expect in a robotic thyroidectomy?

In a robotic thyroidectomy, your surgeon accesses the thyroid gland through an incision under the arm. Called an axillary approach, it leaves no scar on the neck.

For the thyroidectomy incisions, one option is a 5 – 7cm long incision and another very small 5 mm incision in the chest. Another option is 3 keyhole incisions of up to 1.5cm in the axilla and another 5mm one in the chest.

During the procedure:

• The surgeon sits at the console of the robot-assisted surgical system where they will control 4 robotic hands and see images from a high-definition 3D camera
• The small robotic hands are very small, allowing the surgeon to make very precise movements
• The 3D camera camera gives the surgeon a 3D image of the thyroid and allows them to zoom in to get an even more detailed look
• The 4 robotic hands and the 3D camera are inserted through the incisions. Your surgeon can then accurately remove part or all of the thyroid.

The robot-assisted surgical system is completely under the control of the surgeon. The robotic hands cannot move on their own and the system cannot be programmed. The surgeon must be there to manipulate the robot and make decisions during the surgery.

After the procedure

There will be some soreness at the surgical site but you will be able to eat and drink, move around and perform tasks of daily living normally the day after your surgery.

There will be a surgical drain (similar to open surgery), which will usually be removed 3 – 5 days after the surgery depending on the amount of drainage. You may choose to be discharged from hospital with the drain 1 day after surgery or remain until the drain is removed.

Sutures are removed after 7 days.

Care and recovery period for a robotic thyroidectomy

The recovery time for robotic thyroidectomy is about the same as for open or endoscopic surgery.

Following the surgery, you can expect to spend either 1 day or 3 – 5 days in the hospital depending on whether you are comfortable going home with the drain.