Whatever happened to robotic thyroidectomy?

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.