Surgical Safety and Oncologic Effectiveness in Robotic versus Conventional Open Thyroidectomy in Thyroid Cancer: A Systematic Review and Meta-Analysis

Although many experiences using the da Vinci Robot System have been reported by several groups, there is substantial controversy over the role of the robot in thyroidectomy. We performed a systematic review and meta-analyses in order to evaluate the safety and effectiveness of robotic thyroidectomy (RT) compared with open thyroidectomy (OT) in thyroid cancer. A literature search for the systematic review was conducted using English databases (Ovid MEDLINE, Ovid EMBASE, and the Cochrane Library), as well as domestic databases, up to June 2014.Outcomes of interest included demographic characteristics, adverse events and complications, and outcomes of effectiveness. Fourteen publications including 3,136 cases were finally selected for the systematic review and meta-analysis. RT was associated with an equivalent complication rate including transient and permanent hypocalcemia, transient and permanent recurrent laryngeal nerve palsy, bleeding, chyle leakage, seroma, length of hospital stay, and postoperative thyroglobulin level when compared with OT. RT also had lesser blood loss (weighted mean difference [WMD]-0.28, p = 0.04), better cosmetic satisfaction (odds ratio 4.79, p < 0.001), and lower level of swallowing impairment (WMD -4.17, p < 0.001) than OT. OT was in favor of operation time (WMD 39.77, p < 0.001) and retrieved lymph nodes (WMD -0.62, p = 0.02) compared with RT. RT seems to be associated with a lesser amount of estimated blood loss, better cosmetic satisfaction, and a low level of swallowing impairment, while OT was associated with a shorter operation time and more retrieved lymph nodes. Randomized clinical trials with large samples and comparative studies that reflect long-term follow-up data are needed to validate our findings.