A Novel Technique for the Resection of the Symptomatic Lingual Thyroid: Transoral Robotic Surgery

Abstract

Background: Treatment of the symptomatic lingual thyroid is typically accomplished through surgical resection using a transcervical approach, which carries a high risk of treatment-related morbidity and leaves a visible scar on the neck. In order to reduce morbidity and eliminate visible scarring, this study utilized transoral robotic surgery (TORS) in performing lingual thyroidectomy. Methods: Between October 2009 and October 2010, three patients with symptomatic lingual thyroid were enrolled in this prospective study. Primary symptoms included dysphagia (two patients) and hemorrhage (one patient). A da Vinci robotic system (Intuitive Surgical, Inc., Sunnyvale, CA) was used to perform TORS in all patients. A face-up 30 degrees endoscope was inserted through the oral cavity, and two instruments were positioned on either side of the endoscope. We evaluated the robotic set-up time, operating time, volume of blood loss, surgery-related complications, postoperative symptomatic improvement, and cosmetic results. Results: The transoral robotic lingual thyroidectomy was successfully performed in all patients. The mean operating time was 43 minutes (range 35-50 minutes), and an average of 11 minutes (range 10-15 minutes) was required to set up the robotic system. All patients were satisfied with their cosmetic results and the improvement of their symptoms after the operation. There were no perioperative complications or significant bleeding. The average volume of blood loss during the operation was 25mL. Conclusions: The use of TORS for lingual thyroidectomy was both technically feasible and safe, suggesting that it may be considered a viable alternative to other invasive surgical approaches in patients with symptomatic lingual thyroid.