Thyroid surgery : SPRA (Single Port Robotic Areola) Thyroidectomy

초록

In the era of oncoplastic thyroid surgery, various approaches have been developed and being actively performed in these days. Among the many types of robot surgery approach, bilateral axillary breast approach (BABA) method has many advantages such as symmetric view of both thyroid glands that enables easily perform the total thyroidectomy under the same vision, and thyroidectomy procedure is same as open surgery. However, pitfalls of BABA method are difficult to make subcutaneous flap dissection before the robot rocking and wide chest area flap dissection area compared to other thyroid surgery methods. I developed the world’s first new thyroidectomy method that evolved from the BABA using da-Vinci SP system and named it as “Single Port Robotic Areolar approach thyroidectomy (SPRA)”. In SPRA, da-Vinci SP robot docks through 3cm sized circum-areolar incision on the right breast. Subcutaneous skin flap was created from the areolar to thyroid cartilage, using blunt dissection and advanced bipolar. 7mmHg CO2 gas inflation was used during the surgery. Thyroidectomy procedure is same as previous BABA method, simultaneous access to bilateral thyroid glands and lateral neck area without changing the robot docking. Recently, I published a research paper comparing the SPRA (n=111) and BABA surgery (n=159) performed for one year in 2023. According to the results of this study, SPRA surgery took less time to create a flap, shorter overall surgery time, less postoperative drainage, and a shorter hospital stay compared to BABA. In addition, stimulated thyroglobulin level before the radioactive iodine therapy was 1.03 ? 0.74. Although our study is early experience, I suggest that SPRA surgery is a good surgical method that preserves the advantages of BABA surgery and adds the advantages of minimally invasive surgery using da-Vinci SP.