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August 19, 2020

Distant-Access Robotic Thyroidectomy—Is It Worth the Cost?

Author Affiliations
  • 1Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston
  • 2Department of Surgery and MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, Illinois
JAMA Surg. 2020;155(11):1010-1012. doi:10.1001/jamasurg.2020.1491

In 1923, Charles H. Mayo, MD, reported to the American Surgical Association the development of a safe thyroid operative technique that was grounded in attention to detail and avoidance of technical errors. With his technical standardization, morbidity and mortality rates for thyroidectomy, especially in Graves disease, were reduced to a minimum of less than 0.6%.1 Almost a century later, Dr Mayo’s technique is still consistently performed with reproducible results. Despite its consistent safety, new technologies have evolved and distant-access thyroid resection techniques have been pursued. Innovative approaches via the axilla, retroauricular region, breast, and oral cavity began to proliferate in 2009, mainly outside of the US. The main advantage has been a more desirable cosmetic outcome. The initial North American experiences were subject to considerable criticism for the relatively high rate of complications and significantly increased use of resources.2,3 Today, interest in all but the transoral approach has dwindled. Studying surgical techniques that are potentially more efficient is important, but until proven to be better, it is necessary that distant-access thyroidectomy be used sparingly and judiciously.4

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    1 Comment for this article
    Better Mouse Trap
    Mark Komorowski, MD | Private practice
    As a Plastic Surgeon who completed a five year General Surgery Program (Board Certified) and a Trauma Fellowship I'm always amused that a better mouse trap is needed no matter the adequacy of the current. Certainly impressed that non Plastic Surgeons have taken appearance of a surgical scar important. One of the reasons I left GS was the erosion of surgical geography to newly designed sub groups ie Breast Surgeons, Endocrine Surgeons and Hernia Specialists. Using a new hammer, Robotic Surgery, doesn't make the world a nail. My prediction in 20 years there will be a Fellowship in Open Surgery.