"Three-in-One Wonder": A Retrospective Cohort Study on Modified Robotic-Assisted Transoral Thyroidectomy

Importance. With advancements in robotic surgery, robotic-assisted thyroidectomy is gaining popularity. The introduction of the 3-port transoral robotic thyroidectomy (T-TORT) offers an alternative approach with potential benefits in postoperative recovery compared to traditional methods. Objective. To assess the safety and feasibility of T-TORT in comparison to the transoral endoscopic thyroidectomy vestibular approach (TOETVA). Design. A retrospective cohort study with 1:1 propensity score matching was conducted to compare perioperative outcomes between T-TORT and TOETVA. The learning curve was analyzed using cumulative summation (CUSUM). Setting. Tertiary A hospital. Participants. One hundred sixty-two patients who underwent either T-TORT or TOETVA were included. Intervention or Exposures. The T-TORT group underwent three-port robotic thyroidectomy, while the TOETVA group received standard transoral vestibular endoscopic thyroidectomy. Main Outcomes and Measures. Demographics and perioperative data were compared. The learning curve was evaluated using CUSUM. Results. Compared with the TOETVA group the operation time in minutes of the T-TORT group was relatively longer (136.14 +/- 36.52 vs 122.49 +/- 34.85, P = .012), the postoperative stay, in days, was shorter (2.77 +/- 0.78 vs 3.51 +/- 0.95, P < .001), the drainage volume on a postoperative day 1 (POD1) and POD2, in milliliter, was less (POD1 56.57 +/- 23.29 vs 65.12 +/- 26.04, P = .029 and POD2 27.43 +/- 25.29 vs 38.21 +/- 25.09, P = .008). The other statistics, including bleeding amount, retrieved and metastatic central lymph nodes, visual analog scale score, and drainage volume on an operative day were comparable between the 2 groups. Meanwhile, there were no significant differences between the 2 groups in postoperative complication rates. The turning point of the learning curve was in the 16th case with a hemithyroidectomy with central neck dissection (CND) and the 21st case with a bilateral thyroidectomy with CND. Conclusions and Relevance. T-TORT is a safe and feasible option with enhanced postoperative recovery compared to TOETVA. It may be a preferable choice in specific clinical situations. Trial Registration. This study was registered at the Chinese Clinical Trial Registry (UIN: ChiCTR2300069021, https://www.chictr.org.cn) in accordance with the World Medical Association's Declaration of Helsinki, 2013.