Systematic review and meta-analysis of robotic vs conventional thyroidectomy approaches for thyroid disease.

OBJECTIVE This study compared postoperative technical, quality-of-life, and cost outcomes following either robotic or open thyroidectomy for thyroid nodules and cancer. DATA SOURCES PubMed, Ovid MEDLINE, EMBASE, ISI Web of Science, and the Cochrane Central Register of Controlled Trials. REVIEW METHODS We examined relevant controlled trials, comparative effectiveness studies, and cohort studies for eligible publications. We calculated the pooled relative risk for key postoperative complications, mean differences for operative time, and standardized mean differences for length of stay (LOS) using random effects models. Quality-of-life outcomes were summarized in narrative form. RESULTS The meta-analysis comprised 11 studies with 726 patients undergoing robotic transaxillary or axillo-breast thyroidectomy and 1205 undergoing open thyroidectomy. There were no eligible cost-related studies. Mean operative time for robotic thyroidectomy exceeded open thyroidectomy by 76.7 minutes, while no significant difference in LOS was identified. There were no significant differences in hematoma, seroma, recurrent laryngeal nerve injury, hypocalcemia, or chyle leak rates. The systematic review included 12 studies. Voice, swallowing, pain, and paresthesia outcomes showed no significant differences between the 2 approaches. The robotic cohort reported higher cosmetic satisfaction scores, although follow-up periods did not exceed 3 months and no validated questionnaires were used. CONCLUSIONS Transaxillary and axillo-breast robotic and open thyroidectomy demonstrate similar complication rates, but robotic approaches may introduce the risk of new complications and require longer operative times. Robotic thyroidectomy appears to improve cosmetic outcomes, although longer follow-up periods and use of validated instruments are needed to more rigorously examine this effect.