In case you missed it, there was a brief romance between
thyroid surgeons and robots. Thyroid surgeons, itching to join the crowds
migrating to robot-assisted surgery, came up with the idea to use the robot to
perform thyroidectomies.
It appears that the push began in Korea, and to add some
pizzazz to the mix, a trans-axillary approach to avoid a scar in the neck was
incorporated. As is often the case, the initial results were favorable.
Then reality set in.
The early euphoria gave way to the revelation that American
patients were larger and more difficult to operate on than patients in Korea.
But randomized trials of selected patients were suggested.
A paper from Wayne State in Detroit found complications in 4 (22%) of 18
cases—3 temporary vocal cord pareses and a post-operative hematoma that
required re-operation. Hospital stay was a median of 2 days.
More
than 90% of conventional thyroidectomy patients are done as same day surgeries.
After receiving 13 reports of complications, Intuitive
Surgical, the company that manufactures the robot, decided it could no longer
support the use of its robot for thyroid surgery.
At this point, a surgeon from the MD Anderson Cancer Center
took the unprecedented step of publicly renouncing her previous stand on
robotic-assisted thyroid surgery (RATS).
In an
editorial in the December 2012 issue of the journal Surgery, she said, "After performing nearly 40 RATS
procedures, we came to the conclusion that the main benefit of RATS—translocation
of the surgical incision to the axilla—did not offset the risks and liability
of performing an operation that was not supported by the equipment
manufacturer, took twice as many resources to perform as open surgery, and
faces complex legal hurdles beyond our control that currently prevent
implementation of telerobotic/distant access surgery across the United States.
Justifying the expense in a time when demands outweigh resources obligated us
to focus on outcomes. When we did that, we proved that we could perform RATS,
but not that we should."
Here's a link to a series of photos showing exactly how
robot-assisted thyroidectomy was done. It looks like one trades a thin scar in
the neck for an ugly scar in front of the armpit.
There are still hospital websites that say they offer the
procedure. Here is one. Google "robotic thyroidectomy" and you will
see.
Maybe they didn't get the memo.
8 comments:
You'd think the acronym would have given them pause.
Yes, RATS is not the most appealing acronym. How does one say to a patient "I am booking you for a RATS?"
Obviously there is a strong bias. Only a true skilled surgeon can perform the surgery properly. In all surgeries there are risks. As far as I have researched it's more precise and accurate. I am a patient who needs this surgery and I don't wish to have an ugly archaic Frankenstein scar across my young pretty neck. I small scar under my arm is more unsightly not to mention easier to heal. I'm may not even go through surgery if it's not cancer, but I F I do, I'll stick with the more precise surgery.
Ritalee, thanks for commenting. Many scars from standard thyroid surgery are invisible if placed in a neck skin crease. If you go to the link about how robotic thyroidectomy is done that I posted, you will see that the scar is neither small nor under the arm. And that was presumably a good result or it would not have been used to illustrate the procedure.
Whatever happens, I hope you do well. Good luck.
I just finished my gen surg rotation as an M3 at a community hospital that serves the more affluent population of our town (capital in a Midwest state) and they still do RATS there.
However at the academic center that typically doesn't get affluent patients they do the standard approach.
Interesting.
Isn't that strange? What could possibly account for that difference? :-)
Obviously it is the cost of procedure.Robotic thyroidectomy is a step forwards but probably it's time has not come globally yet.
Honestly, I doubt that its time will ever come.
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