Scarless thyroid surgery

I have just returned from the 9th International Robotic Surgery Symposium (IRSS) in Seoul, Korea. This is the third in a series of five blog posts;

  1. Neoadjuvant immunotherapy and transoral robotic surgery (TORS)
  2. Obstacles to improving treatment regimens in head and neck cancer
  3. Scarless surgery – the future of thyroid surgery is robotic
  4. Controlling postoperative bleeding – my IRSS paper
  5. Future of surgical robots – single ports and flexible endoscopes

Transoral robotic surgery is most often used in Australia to excise oropharyngeal cancers. In my own practice I have also used it to perform scarless thyroid, submandibular gland, and schwannoma surgery. While attending the IRSS meeting in Seoul,  I was impressed by the different ways transoral robotic (TORS) surgeons have adopted the robot to perform other types of head and neck surgery, particularly thyroid surgery.

Surgical robots are all about minimally invasive surgery (MIS). One of the major advantages of robotic surgery is relatively scarless surgery. This is particularly important to populations which have a genetic predisposition to keloid scarring.

Robotic Neck Dissections

I was extremely impressed with the way South Korean surgeons have adopted the robot to perform neck dissections. A robotic neck dissection requires an incision at the back of the ear, similar to the incision for a facelift. But as we discussed at the symposium, this is approach is not just about cosmesis. A robotically performed neck dissection may reduce the amount of lymphedema and other side effects we routinely see in patients who have undergone conventional neck dissection surgery.

Robotic Thyroid Surgery

Robotic thyroid and parathyroid surgery was also a popular topic. Transoral Robotic Submandibular Sialodenectomy (TORSS) and endoscopic approaches are examples of the range of minimally invasive surgical techniques available in countries other than Australia. It is all about the incision which is either behind the ear as per face-lift incisions, or going through the gum in front of the lower teeth and then down into the neck. The large case series presented at the symposium rebut suggestions that this is experimental surgery. Several of the speakers at the meeting were presenting papers with well over a thousand cases in the series:

  1. Ralph P Tufano, The Johns Hopkins University, USA – Transoral Thyroid and Parathyroid Surgery: The Value of Leaving No Trace
  2. Kyung Te, Hanyang University, Korea – Robotic and Endoscopic Thyroid Surgery: Advance of Transoral Approach
  3. Woon Youn Chung, Yonsei University, Korea – Robotic Thyroid Surgery: A High-Volume Experience in Severance Hospital
  4. Emad Kandil, Tulane University New Orleans, USA – Current Status of Remote Access Thyroid Surgery in USA
  5. Patrick Aidan, Hôpital Américain de Paris, France – European Experience of Robotic Thyroid Surgery: About 1000 cases
  6. Angkoon Anuwong, Police General Hospital, Siam University, Thailand – Lesson Learned from 1700 Cases of 5 Years Experience of Transoral Endoscopic Thyroidectomy
  7. Jonathon O. Russell, Stanford University, USA – Thyroid 2020: Scarless Surgery, Surgery-Less treatment
  8. Micaela Piccoli, Ospedale Civile Sant’Agostino Estense, Italy – Evolution Strategies in Trasaxillay Robotic Thyroidectomy: Italian Experience

As you can see from this list, robotic thyroid surgery is happening in Korea, USA, France, Thailand, and Italy in large numbers. Conventional thyroid surgeons, consider yourselves warned. The future of thyroid surgery is scarless and it lies in the hands of robotic surgeons.

I would like to thank Se-Heon Kim, MD, PhD and The Korean Society of Head and Neck Surgery Yonsei University College of Medicine for inviting me to join the faculty of the 9th International Robotic Surgery Symposium, held in Seoul, Korea, October 25-27, 2019