{"title":"Who is difficult for transoral robotic thyroidectomy? A prospective analysis of 76 lobectomies.","authors":"Man Hon Tang, Moon Young Oh, Young Jun Chai","doi":"10.1016/j.surg.2026.110602","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Transoral robotic thyroidectomy can be technically demanding, particularly during the early learning phase. This study aimed to identify preoperative factors associated with increased surgeon's subjective difficulty in transoral robotic thyroidectomy lobectomy.</p><p><strong>Methods: </strong>This prospective observational study included consecutive 3-port transoral robotic thyroidectomy lobectomy cases performed between January and September 2025 by a single endocrine surgeon. The procedure was divided into 4 key steps, each graded on a 1-3 subjective difficulty scale. An overall difficulty score (range, 4-12) was calculated by summing step scores, and cases were classified as standard (4-5) or difficult (≥6). Patient anthropometric, clinicopathologic, operative, and postoperative variables were compared between groups.</p><p><strong>Results: </strong>A total of 76 transoral robotic thyroidectomy lobectomies (38 right-sided and 38 left-sided) were analyzed; 62 patients (81.6%) were female. Overall, 27 cases (35.5%) were classified as difficult. Difficult cases had longer operative time than standard cases (91.8 vs 71.7 minutes, P < .001), representing a 28.0% increase. Compared with the standard group, the difficult group had a higher proportion of male patients (37.0% vs 8.2%, P = .004), higher body mass index (25.7 vs 23.8 kg/m<sup>2</sup>, P = .038), and deeper tracheal depth (24.4 vs 22.1 mm, P = .002). Clinicopathologic factors were not significantly associated with overall difficulty.</p><p><strong>Conclusion: </strong>Male sex, higher body mass index, and greater tracheal depth were associated with increased technical difficulty in transoral robotic thyroidectomy lobectomy. These factors may help inform preoperative case selection and operative planning in appropriately selected transoral robotic thyroidectomy candidates; however, further validation is needed before direct applicability to surgeons in the early learning phase can be assumed.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110602"},"PeriodicalIF":3.2000,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.surg.2026.110602","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Transoral robotic thyroidectomy can be technically demanding, particularly during the early learning phase. This study aimed to identify preoperative factors associated with increased surgeon's subjective difficulty in transoral robotic thyroidectomy lobectomy.
Methods: This prospective observational study included consecutive 3-port transoral robotic thyroidectomy lobectomy cases performed between January and September 2025 by a single endocrine surgeon. The procedure was divided into 4 key steps, each graded on a 1-3 subjective difficulty scale. An overall difficulty score (range, 4-12) was calculated by summing step scores, and cases were classified as standard (4-5) or difficult (≥6). Patient anthropometric, clinicopathologic, operative, and postoperative variables were compared between groups.
Results: A total of 76 transoral robotic thyroidectomy lobectomies (38 right-sided and 38 left-sided) were analyzed; 62 patients (81.6%) were female. Overall, 27 cases (35.5%) were classified as difficult. Difficult cases had longer operative time than standard cases (91.8 vs 71.7 minutes, P < .001), representing a 28.0% increase. Compared with the standard group, the difficult group had a higher proportion of male patients (37.0% vs 8.2%, P = .004), higher body mass index (25.7 vs 23.8 kg/m2, P = .038), and deeper tracheal depth (24.4 vs 22.1 mm, P = .002). Clinicopathologic factors were not significantly associated with overall difficulty.
Conclusion: Male sex, higher body mass index, and greater tracheal depth were associated with increased technical difficulty in transoral robotic thyroidectomy lobectomy. These factors may help inform preoperative case selection and operative planning in appropriately selected transoral robotic thyroidectomy candidates; however, further validation is needed before direct applicability to surgeons in the early learning phase can be assumed.
背景：经口机器人甲状腺切除术在技术上要求很高，特别是在早期学习阶段。本研究旨在探讨经口机器人甲状腺切除术中外科医生主观难度增加的术前因素。方法：这项前瞻性观察研究纳入了2025年1月至9月由一名内分泌外科医生进行的连续三口经口机器人甲状腺切除术。整个过程分为4个关键步骤，每个步骤都有1-3个主观难度等级。将步骤得分相加，计算总体难度评分（范围4-12），并将病例分为标准（4-5）和困难（≥6）两类。比较两组患者的人体测量、临床病理、手术和术后变量。结果：共分析76例经口机器人甲状腺切除术（右侧和左侧各38例）；女性62例（81.6%）。其中27例（35.5%）为难治性。困难病例比标准病例手术时间更长（91.8分钟vs 71.7分钟，P < 0.001），延长28.0%。与标准组相比，困难组男性患者比例更高（37.0% vs 8.2%, P = 0.004），体重指数更高（25.7 vs 23.8 kg/m2, P = 0.038），气管深度更深（24.4 vs 22.1 mm, P = 0.002）。临床病理因素与总体难度无显著相关。结论：男性、较高的身体质量指数和较大的气管深度与经口机器人甲状腺切除术的技术难度增加有关。这些因素可能有助于术前病例选择和手术计划，以适当选择经口机器人甲状腺切除术候选人；然而，在早期学习阶段直接适用于外科医生之前，还需要进一步的验证。
期刊介绍：
For 66 years, Surgery has published practical, authoritative information about procedures, clinical advances, and major trends shaping general surgery. Each issue features original scientific contributions and clinical reports. Peer-reviewed articles cover topics in oncology, trauma, gastrointestinal, vascular, and transplantation surgery. The journal also publishes papers from the meetings of its sponsoring societies, the Society of University Surgeons, the Central Surgical Association, and the American Association of Endocrine Surgeons.
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