ASO Author Reflections: The Application of Transoral Robotic Thyroidectomy (TORT) for Papillary Thyroid Carcinoma
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ASO AUTHOR REFLECTIONS
ASO Author Reflections: The Application of Transoral Robotic Thyroidectomy (TORT) for Papillary Thyroid Carcinoma Dora K. C. Tai, MD1, and Hoon Yub Kim, MD, PhD, FACS2,3 Department of Surgery, Queen Elizabeth Hospital, Kowloon, Hong Kong; 2Department of Surgery, Korea University Thyroid Center, Korea University College of Medicine, Seoul, Republic of Korea; 3Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA 1
PAST
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The increase in demand for cosmesis and surgical excellence resulting in the improvement of postoperative quality of life has led to the development of remote-access thyroid surgery. Amongst various approaches for remoteaccess thyroidectomy, the recently developed transoral approach has gained huge popularity because of the advantages of a short distance from the oral vestibule to the neck, resulting in less tissue dissection than others such as the midline approach with direct access to bilateral lobes of thyroid gland and central compartment, and excellent cosmesis, as incisions are made in the lower lip mucosa, so the neck is truly scarless.1 Transoral robotic thyroidectomy(TORT) has the added benefits of high-definition three-dimensional view, wristed instruments, tremor elimination, and use of four ports, which allows for independent countertraction and precise dissection of thyroid carcinomas with preservation of important structures such as the recurrent laryngeal nerve and parathyroid glands.1,2 TORT has mostly been applied in patients with papillary thyroid microcarcinomas smaller than 1 cm, which usually show indolent clinical course, whereas this study explores the feasibility of TORT for papillary carcinomas larger than 1 cm.3
This study showed that, when comparing TORT in papillary thyroid carcinomas \ 1 cm and C 1 cm, there were no significant differences in outcomes or complications except for a longer operative time in the C 1 cm group. In addition, there were no locoregional or distant recurrences found. Although there are limitations to our study such as its retrospective design and the relatively small number of patients in the C 1 cm group, overall, we believe that we demonstrated that TORT can be successfully performed for larger papillary thyroid carcinomas and not just micropapillary carcinomas. FUTURE One of the current limitations of TORT is the difficulty in performing lateral neck dissection,4 which we hope to overcome with further modifications in surgical techniques and advances in technology. In addition, with the accumulation of experience, the application of TORT may be widened to surgical treatment of most thyroid cancers including medullary thyroid carcinoma. Currently, there is interest in the application of a single-port robotic surgical system to perform thyroid surgery, and a preclinical feasibility study on two human cadavers has been performed.5 This new technology, if successful, may elevate TORT to unquestionable scarless surgery with elimination of the smal
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