Thyroid nodules are a common problem that a clinician faces in his practice. The vast majority of these nodules are benign and unless progressing or causing symptoms, they are usually left alone and not operated upon. However, a small percentage (about 5%) of these nodules can be cancerous (malignant) and surgery becomes mandatory to remove the diseased gland. Quite often, the challenge facing the clinician is to differentiate between benign and cancerous nodules. When investigations such as ultrasound and needle aspiration do not resolve the issue, surgery is often recommended.
Surgery of the thyroid is done through an incision in the lower part of the neck. In most cases the incision heals well leaving behind a fine scar; but some people have a tendency to form thick and unsightly scars. Additionally, a neck scar may be psychologically upsetting to young patients. With the advent of the Robotic surgical systems, it is now possible to do thyroid surgery without opening the neck and without leaving a visible scar.
The Robotic system is a revolutionary innovation devised for performing surgical procedures in otherwise difficult or impossible locations using specially designed robotic arms. The robotic arms are controlled by a computer console which the surgeon operates using hand and foot controls – somewhat like a video-game, but a thousand times more precise and sophisticated.
The endo-wrist attached to these arms can move in different directions and at multiple angles (270 degrees) – something that the human wrist cannot and therefore can dissect, suture and divide tissues with a precision that even the most dexterous surgeon cannot. An endoscopic camera provides a 3-D magnified view of the surgical field when viewed through the console; making structures like nerves, blood vessels etc. much larger and therefore more easily visible enabling faster surgery with more precision. Using small and hidden incisions surgeons can remove complex tumors minimizing tissue damage, hastening recovery and reducing hospitalization.
Though the robot facilitates the surgery, it is the operating surgeon’s hand movements that are transmitted to the robotic arms and the surgeon continues to direct the operation. The motion scaling with tremor filtration that is incorporated in the newer generation robotic systems (da Vinci Si) eliminate tiny, uncontrolled movements in the surgeon’s arms making surgery much more precise. The main application of this system has been in cancer, cardiac and urologic surgery.
Robotic thyroid surgery for benign and cancerous nodules of the thyroid gland is done through an incision in the axilla (arm-pit) thus avoiding a visible scar in the neck. Specially designed retractors allow the robotic arms to reach the neck region and remove the thyroid without cutting open the neck.
Other applications of the robot in cancer surgery include;
- Trans-oral robotic surgery (TORS) – surgery for cancer of the throat via the mouth.
- Robotic gastro-intestinal and colorectal surgeries through tiny abdominal ports avoiding large incisions and extensive mobilization of abdominal organs, thus hastening recovery and minimizing complications from these surgeries
- Gynaecological procedures including hysterectomy, myomectomy (removal of fibroids) and other pelvic surgeries.
- Robotic radical prostatectomy for early and localized cancer of the prostate.
Many other indications are still evolving as the superiority of this technique over open and laparoscopic surgery is being established and with time, robotic surgery is expected to replace other conventional methods of surgery.
Dr. Umanath Nayak,
Consultant Head & Neck and Robotic surgeon, Apollo Cancer Hospitals, Hyderabad, India
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