Robotic thyroidectomy versus endoscopic thyroidectomy: a meta-analysis
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WORLD JOURNAL OF SURGICAL ONCOLOGY
REVIEW
Open Access
Robotic thyroidectomy versus endoscopic thyroidectomy: a meta-analysis Shuang Lin1†, Zhi-Heng Chen1†, Hong-Gang Jiang1 and Ji-Ren Yu2*
Abstract Background: To conduct a meta-analysis to determine the relative merits of robotic thyroidectomy (RT) and endoscopic thyroidectomy (ET). Methods: A literature search was performed to identify comparative studies reporting peri-operative outcomes for RT and ET. Pooled odds ratios (ORs) and weighted mean differences (WMDs) with 95% confidence interval (95% CI) were calculated using either a fixed-effects or a random-effects model. Results: Six studies matched the selection criteria, which reported on 2048 subjects, of whom 978 underwent RT and 1070 underwent ET. Comparing the outcomes of RT with ET, this meta-analysis indicated that RT was associated with more complications (WMD = 1.51, 95% CI 1.18 to 1.94) and greater amount of drainage fluid (WMD = 17.10, 95% CI 5.69 to 28.51). Meanwhile, operating time (WMD = 1.50, 95% CI −39.59 to 42.58), conversion (WMD = 0.63, 95% CI 0.07 to 6.17), post-operative hospital stay (WMD = −0.05; 95% CI −0.18 to 0.08), and the number of lymph nodes harvested (WMD = 0.62, 95% CI −0.29 to 1.53) were similar for both procedures. Conclusion: The results of this meta-analysis indicated that RT is associated with an increased risk of complications and a greater amount of drainage fluid. Therefore, RT does not appear to have any advantage over ET. Further studies are required to confirm these results. Keywords: Robotic thyroidectomy, Endoscopic thyroidectomy, Da Vinci robotic system, Meta-analysis
Review Introduction
Since the first report of endoscopic thyroid lobectomy in 1997 [1], various endoscopic thyroid techniques or approaches have been described [2,3]. Many studies have reported several advantages of endoscopic thyroidectomy (ET) compared with open thyroidectomy, including better cosmetic results, a lower rate of post-operative complications, and better completion rate for surgery [4,5]. However, ET remains a technically challenging procedure. The two-dimensional visual representation and use of nonflexible endoscopic instruments can make it difficult to visualize the surgical field adequately and to manipulate instruments. The Da Vinci robotic system was developed to improve the weak points of endoscopic surgery, and surgical * Correspondence: [email protected] † Equal contributors 2 Department of Surgery, First Affiliated Hospital, Medical College, Zhejiang University, Hangzhou 310003, Zhejiang Province, China Full list of author information is available at the end of the article
robots have been successfully applied to a number of disciplines [6-8]. Recent studies have reported that robotic thyroidectomy (RT) is a feasible, safe, and effective method of performing such surgeries [9,10], although most studies have been limited by small samples size and assessment at a single institution. In this study, we aimed to determine the relative merits of RT and ET by performing a meta-
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