达芬奇机器人在甲状腺癌治疗中的应用进展
Application Advances of da Vinci Robotic System in Thyroid Cancer Treatment
DOI: 10.12677/jcpm.2025.44423, PDF,    科研立项经费支持
作者: 王志浩*, 李志远:济宁医学院临床医学院(附属医院),山东 济宁;王 伟#:济宁市第一人民医院乳甲外科,山东 济宁
关键词: 甲状腺切除术甲状腺癌达芬奇机器人手术入路Thyroidectomy Thyroid Cancer Da Vinci Robotic System Surgical Approaches
摘要: 甲状腺癌作为头颈部最常见的恶性肿瘤之一,其发病率在全球范围内呈上升趋势。手术切除是目前治疗甲状腺癌的主要方法,传统的甲状腺癌外科手术存在创伤大、恢复慢、颈部遗留明显瘢痕的局限性。机器人甲状腺切除术以其精确的操作和微创的优势,为甲状腺癌患者提供新的治疗选择。然而,机器人甲状腺切除术尚未普及,且不同手术入路机器人手术系统在甲状腺切除术中的临床效果、适应症仍有待商榷。本文对达芬奇机器人甲状腺切除术在甲状腺癌治疗起源和探索、发展进程、适应证、禁忌证、术后并发症、手术优势和局限性进行总结,就近年来达芬奇机器人甲状腺手术的研究进展进行综述。
Abstract: Thyroid cancer, as one of the most common malignancies in the head and neck region, has shown an increasing incidence worldwide. Surgical resection remains the primary treatment for thyroid cancer, yet conventional thyroidectomy is limited by significant trauma, slow recovery, and prominent neck scarring. Robotic thyroidectomy, with its precise manipulation and minimally invasive advantages, offers a novel therapeutic option for thyroid cancer patients. However, robotic thyroidectomy has not yet been widely adopted, and the clinical efficacy and indications of different robotic surgical approaches for thyroidectomy remain debatable. This article summarizes the origins, evolution, indications, contraindications, postoperative complications, advantages, and limitations of da Vinci robotic thyroidectomy in thyroid cancer treatment. It also reviews recent research advances in da Vinci robotic thyroid surgery.
文章引用:王志浩, 李志远, 王伟. 达芬奇机器人在甲状腺癌治疗中的应用进展[J]. 临床个性化医学, 2025, 4(4): 108-116. https://doi.org/10.12677/jcpm.2025.44423

参考文献

[1] Sung, H., Ferlay, J., Siegel, R.L., Laversanne, M., Soerjomataram, I., Jemal, A., et al. (2021) Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA: A Cancer Journal for Clinicians, 71, 209-249. [Google Scholar] [CrossRef] [PubMed]
[2] 中华人民共和国国家卫生健康委员会医政医管局. 甲状腺癌诊疗指南(2022年版) [J]. 中国实用外科杂志, 2022, 42(12): 1343-1357+1363.
[3] 张新洲, 刘劲松, 许娴, 等. 2005-2016年中国甲状腺癌发病和死亡趋势分析[J]. 中华肿瘤防治杂志, 2022, 29(24): 1725-1733.
[4] Nabhan, F., Dedhia, P.H. and Ringel, M.D. (2021) Thyroid Cancer, Recent Advances in Diagnosis and Therapy. International Journal of Cancer, 149, 984-992. [Google Scholar] [CrossRef] [PubMed]
[5] 刘坤鹏, 邢宝平. 甲状腺恶性肿瘤外科手术治疗进展[J]. 中国临床研究, 2020, 33(5): 697-699.
[6] ElKordy, M.A., ElBaradie, T.S., ElSebai, H.I., Amin, A.A.E. and KhairAlla, S.M. (2018) Osteosarcoma of the Jaw: Challenges in the Diagnosis and Treatment. Journal of the Egyptian National Cancer Institute, 30, 7-11. [Google Scholar] [CrossRef] [PubMed]
[7] Chae, S., Min, S.Y. and Park, W.S. (2020) Comparison Study of Robotic Thyroidectomies through a Bilateral Axillo-Breast Approach and a Transoral Approach. Journal of Laparoendoscopic & Advanced Surgical Techniques, 30, 175-182. [Google Scholar] [CrossRef] [PubMed]
[8] Kwon, H., Yi, J.W., Song, R., Chai, Y.J., Kim, S., Choi, J.Y., et al. (2016) Comparison of Bilateral Axillo‐Breast Approach Robotic Thyroidectomy with Open Thyroidectomy for Graves’ Disease. World Journal of Surgery, 40, 498-504. [Google Scholar] [CrossRef] [PubMed]
[9] Liu, H., Li, L., Shi, B., Xu, C. and Luo, E. (2017) Robotic Surgical Systems in Maxillofacial Surgery: A Review. International Journal of Oral Science, 9, 63-73. [Google Scholar] [CrossRef] [PubMed]
[10] Park, Y.M., Choi, E.C., Kim, S. and Koh, Y.W. (2021) Recent Progress of Robotic Head and Neck Surgery Using a Flexible Single Port Robotic System. Journal of Robotic Surgery, 16, 353-360. [Google Scholar] [CrossRef] [PubMed]
[11] Park, Y.M., Kim, D.H., Kang, M.S., Lim, J.Y., Choi, E.C., Koh, Y.W., et al. (2019) The First Human Trial of Transoral Robotic Surgery Using a Single-Port Robotic System in the Treatment of Laryngo-Pharyngeal Cancer. Annals of Surgical Oncology, 26, 4472-4480. [Google Scholar] [CrossRef] [PubMed]
[12] Kim, J.K., Choi, S.H., Choi, S.M., Choi, H.R., Lee, C.R., Kang, S., et al. (2021) Single-Port Transaxillary Robotic Thyroidectomy (START): 200-Cases with Two-Step Retraction Method. Surgical Endoscopy, 36, 2688-2696. [Google Scholar] [CrossRef] [PubMed]
[13] Kang, S., Jeong, J.J., Yun, J., Sung, T.Y., Lee, S.C., Lee, Y.S., et al. (2009) Robot-Assisted Endoscopic Surgery for Thyroid Cancer: Experience with the First 100 Patients. Surgical Endoscopy, 23, 2399-2406. [Google Scholar] [CrossRef] [PubMed]
[14] 贺青卿, 周鹏, 庄大勇, 等. 经腋窝与胸前径路da Vinci Si机器人甲状腺腺叶切除二例[J]. 国际外科学杂志, 2014, 41(2): 104-107+147.
[15] An, L., Hwang, K.S., Park, S., Kim, Y.N., Baek, S., Park, S., et al. (2021) Trends of Robotic-Assisted Surgery for Thyroid, Colorectal, Stomach and Hepatopancreaticobiliary Cancer: 10 Year Korea Trend Investigation. Asian Journal of Surgery, 44, 199-205. [Google Scholar] [CrossRef] [PubMed]
[16] He, Q., Tian, W., Wang, P., Wang, X., Bai, Y., Chen, G., et al. (2025) Correction: Chinese Expert Consensus on Transoral Vestibular Approach Robotic Thyroidectomy and Parathyroidectomy (Version 2024). Journal of Robotic Surgery, 19, Article No. 71. [Google Scholar] [CrossRef] [PubMed]
[17] Tae, K. (2021) Robotic Thyroid Surgery. Auris Nasus Larynx, 48, 331-338. [Google Scholar] [CrossRef] [PubMed]
[18] Kim, J.K., Lee, C.R., Kang, S., Jeong, J.J., Nam, K. and Chung, W.Y. (2021) Robotic Transaxillary Lateral Neck Dissection for Thyroid Cancer: Learning Experience from 500 Cases. Surgical Endoscopy, 36, 2436-2444. [Google Scholar] [CrossRef] [PubMed]
[19] Kim, M.J., Nam, K., Lee, S.G., Choi, J.B., Kim, T.H., Lee, C.R., et al. (2017) Yonsei Experience of 5000 Gasless Transaxillary Robotic Thyroidectomies. World Journal of Surgery, 42, 393-401. [Google Scholar] [CrossRef] [PubMed]
[20] Yu, D.Y., Chang, Y.W., Ku, D., Ko, S.Y., Lee, H.Y. and Son, G.S. (2023) Robotic Thyroidectomy Using Gas-Insufflation One-Step Single-Port Transaxillary (GOSTA) Approach. Surgical Endoscopy, 37, 8861-8870. [Google Scholar] [CrossRef] [PubMed]
[21] 李昆临, 王程, 迟昊, 等. 机器人甲状腺手术中相关神经损伤的研究进展[J]. 腹腔镜外科杂志, 2023, 28(3): 222-225.
[22] Chang, E.H.E., Kim, H.Y., Koh, Y.W. and Chung, W.Y. (2017) Overview of Robotic Thyroidectomy. Gland Surgery, 6, 218-228. [Google Scholar] [CrossRef] [PubMed]
[23] Shimazu, K., Shiba, E., Tamaki, Y., Takiguchi, S., Taniguchi, E., Ohashi, S., et al. (2003) Endoscopic Thyroid Surgery through the Axillo-Bilateral-Breast Approach. Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 13, 196-201. [Google Scholar] [CrossRef] [PubMed]
[24] Choe, J., Kim, S.W., Chung, K., Park, K.S., Han, W., Noh, D., et al. (2007) Endoscopic Thyroidectomy Using a New Bilateral Axillo‐Breast Approach. World Journal of Surgery, 31, 601-606. [Google Scholar] [CrossRef] [PubMed]
[25] Lee, K.E., Kim, E., Koo, D.H., Choi, J.Y., Kim, K.H. and Youn, Y. (2013) Robotic Thyroidectomy by Bilateral Axillo-Breast Approach: Review of 1026 Cases and Surgical Completeness. Surgical Endoscopy, 27, 2955-2962. [Google Scholar] [CrossRef] [PubMed]
[26] Liu, P., Zhang, Y., Qi, X., Liu, H., Du, J., Liu, J., et al. (2019) Unilateral Axilla-Bilateral Areola Approach for Thyroidectomy by Da Vinci Robot: 500 Cases Treated by the Same Surgeon. Journal of Cancer, 10, 3851-3859. [Google Scholar] [CrossRef] [PubMed]
[27] 李昆临, 白柯成, 杨明宇, 等. 第四代达芬奇机器人经双侧腋窝乳晕入路甲状腺手术疗效单中心649例分析[J]. 中国普通外科杂志, 2023. 32(11): 1687-1696.
[28] Xu, X., Pan, C., Gao, X., Zhang, L. and Lin, S. (2024) Perioperative Outcomes of Bilateral Axillo-Breast Approach Robotic Thyroidectomy (BABART) versus Minimally Invasive Thyroidectomy (MIT): A Systematic Review and Meta-analysis. Journal of Robotic Surgery, 18, Article No. 136. [Google Scholar] [CrossRef] [PubMed]
[29] Choi, Y.S., Choi, J.H., Jeon, M.S., Yu, M.J., Lee, H.M., Shin, A.Y., et al. (2023) First Experience of Single-Port Robotic Areolar Approach Thyroidectomy. Clinical and Experimental Otorhinolaryngology, 16, 275-281. [Google Scholar] [CrossRef] [PubMed]
[30] Lee, S.M., Hwang, H., Shin, M.H. and Yi, J.W. (2024) One-Year Clinical Experience of Single-Port and Multi-Port Robotic Thyroid Surgery in a Single Institution. Journal of Clinical Medicine, 13, Article No. 5486. [Google Scholar] [CrossRef] [PubMed]
[31] Lee, H.Y., You, J.Y., Woo, S.U., Son, G.S., Lee, J.B., Bae, J.W., et al. (2014) Transoral Periosteal Thyroidectomy: Cadaver to Human. Surgical Endoscopy, 29, 898-904. [Google Scholar] [CrossRef] [PubMed]
[32] 贺青卿, 田文, 王平, 等. 经口腔前庭入路机器人甲状腺和甲状旁腺手术中国专家共识(2023版) [J]. 中国实用外科杂志, 2023. 43(12): 1328-1334.
[33] 余富杰, 赵健洁, 赵大威, 等. 机器人经口腔前庭入路与传统开放性甲状腺癌根治手术的对比研究[J]. 重庆医科大学学报, 2023, 48(6): 662-666.
[34] Kang, Y.J., Cho, J., Stybayeva, G. and Hwang, S.H. (2022) Safety and Efficacy of Transoral Robotic Thyroidectomy for Thyroid Tumor: A Systematic Review and Meta-Analysis. Cancers, 14, Article No. 4230. [Google Scholar] [CrossRef] [PubMed]
[35] Kim, H.K., Kim, H.K., Park, D. and Kim, H.Y. (2019) Robotic Transoral Thyroidectomy: Right Thyroidectomy and Ipsilateral Central Neck Dissection with Da Vinci Si Surgical System. The Journal of Minimally Invasive Surgery, 22, 43-45. [Google Scholar] [CrossRef] [PubMed]
[36] Chai, Y.J., Kim, H.Y., Kim, H.K., Jun, S.H., Dionigi, G., Anuwong, A., et al. (2017) Comparative Analysis of 2 Robotic Thyroidectomy Procedures: Transoral versus Bilateral Axillo‐Breast Approach. Head & Neck, 40, 886-892. [Google Scholar] [CrossRef] [PubMed]
[37] Oh, M.Y., Chai, Y.J., Yu, H.W., Kim, S., Choi, J.Y. and Lee, K.E. (2023) Transoral Endoscopic Thyroidectomy Vestibular Approach vs. Transoral Robotic Thyroidectomy: Systematic Review and Meta-Analysis. Updates in Surgery, 75, 1773-1781. [Google Scholar] [CrossRef] [PubMed]
[38] Tae, K. and Kim, K. (2020) Transoral Robotic Selective Neck Dissection for Papillary Thyroid Carcinoma: Dissection of Levels III and IV. Head & Neck, 42, 3084-3088. [Google Scholar] [CrossRef] [PubMed]
[39] 徐静, 张姝, 姜燕, 等. 经口达芬奇机器人甲状腺乳头状癌手术100例临床分析[J]. 肿瘤预防与治疗, 2024. 37(1): 52-61.
[40] Oh, M.Y., Park, D., Chai, Y.J., Kim, K. and Kim, H.Y. (2024) Transoral Robotic Thyroidectomy: Lessons Learned from Consecutive Series of 1,000 Patients. Surgery, 176, 1627-1634. [Google Scholar] [CrossRef] [PubMed]
[41] Singer, M.C. and Terris, D.J. (2014) Robotic Facelift Thyroidectomy. Otolaryngologic Clinics of North America, 47, 425-431. [Google Scholar] [CrossRef] [PubMed]
[42] Byeon, H.K., Holsinger, F.C., Tufano, R.P., Chung, H.J., Kim, W.S., Koh, Y.W., et al. (2014) Robotic Total Thyroidectomy with Modified Radical Neck Dissection via Unilateral Retroauricular Approach. Annals of Surgical Oncology, 21, 3872-3875. [Google Scholar] [CrossRef] [PubMed]
[43] Byeon, H.K., Kim, D.H., Chang, J.W., Ban, M.J., Park, J.H., Kim, W.S., et al. (2015) Comprehensive Application of Robotic Retroauricular Thyroidectomy: The Evolution of Robotic Thyroidectomy. The Laryngoscope, 126, 1952-1957. [Google Scholar] [CrossRef] [PubMed]
[44] Lee, D.W., Ko, S.H., Song, C.M., Ji, Y.B., Kim, J.K. and Tae, K. (2019) Comparison of Postoperative Cosmesis in Transaxillary, Postauricular Facelift, and Conventional Transcervical Thyroidectomy. Surgical Endoscopy, 34, 3388-3397. [Google Scholar] [CrossRef] [PubMed]
[45] Sung, E.S., Ji, Y.B., Song, C.M., Yun, B.R., Chung, W.S. and Tae, K. (2016) Robotic Thyroidectomy: Comparison of a Postauricular Facelift Approach with a Gas-Less Unilateral Axillary Approach. OtolaryngologyHead and Neck Surgery, 154, 997-1004. [Google Scholar] [CrossRef] [PubMed]
[46] Singer, M.C., Seybt, M.W. and Terris, D.J. (2011) Robotic Facelift Thyroidectomy: I. Preclinical Simulation and Morphometric Assessment. The Laryngoscope, 121, 1631-1635. [Google Scholar] [CrossRef] [PubMed]
[47] Kim, T., Seo, M., Park, S.H., Kim, J.I., Kim, S.J., Kim, J.H., et al. (2022) Feasibility of Robotic Thyroidectomy via Hairline Incision Using Da Vinci Single Port System: Initial Experience with 40 Consecutive Cases. Head & Neck, 44, 2197-2205. [Google Scholar] [CrossRef] [PubMed]
[48] 王猛, 贺青卿, 郑鲁明, 等. 经口腔前庭入路机器人手术系统在儿童甲状腺外科中的应用[J]. 肿瘤预防与治疗, 2023. 36(11): 977-981.
[49] 田文, 孙辉. 超声引导下甲状腺结节和颈部淋巴结细针穿刺活检中国专家共识及操作指南(2025版) [J]. 中国实用外科杂志, 2025, 45(1): 34-41.
[50] Tae, K., Song, C.M., Ji, Y.B., Kim, K.R., Kim, J.Y. and Choi, Y.Y. (2013) Comparison of Surgical Completeness between Robotic Total Thyroidectomy versus Open Thyroidectomy. The Laryngoscope, 124, 1042-1047. [Google Scholar] [CrossRef] [PubMed]
[51] Cho, J., Na, Y. and Kim, H.K. (2023) Age and Post-Lobectomy Recurrence after Endoscopic or Robotic Thyroid Surgery: A Retrospective Cohort Study of 2348 Papillary Thyroid Carcinoma Patients. Cancers, 15, Article No. 5506. [Google Scholar] [CrossRef] [PubMed]
[52] Tae, K., Song, C.M., Ji, Y.B., Sung, E.S., Jeong, J.H. and Kim, D.S. (2016) Oncologic Outcomes of Robotic Thyroidectomy: 5-Year Experience with Propensity Score Matching. Surgical Endoscopy, 30, 4785-4792. [Google Scholar] [CrossRef] [PubMed]
[53] Lee, S.G., Lee, J., Kim, M.J., Choi, J.B., Kim, T.H., Ban, E.J., et al. (2015) Long-Term Oncologic Outcome of Robotic versus Open Total Thyroidectomy in PTC: A Case-Matched Retrospective Study. Surgical Endoscopy, 30, 3474-3479. [Google Scholar] [CrossRef] [PubMed]
[54] Kim, H.K., Chai, Y.J., Dionigi, G., Berber, E., Tufano, R.P. and Kim, H.Y. (2018) Transoral Robotic Thyroidectomy for Papillary Thyroid Carcinoma: Perioperative Outcomes of 100 Consecutive Patients. World Journal of Surgery, 43, 1038-1046. [Google Scholar] [CrossRef] [PubMed]
[55] Kim, W.W., Lee, J., Jung, J.H., Park, H.Y., Tufano, R.P. and Kim, H.Y. (2018) A Comparison Study of the Transoral and Bilateral Axillo‐Breast Approaches in Robotic Thyroidectomy. Journal of Surgical Oncology, 118, 381-387. [Google Scholar] [CrossRef] [PubMed]
[56] Kang, S., Lee, S.C., Lee, S.H., Lee, K.Y., Jeong, J.J., Lee, Y.S., et al. (2009) Robotic Thyroid Surgery Using a Gasless, Transaxillary Approach and the Da Vinci S System: The Operative Outcomes of 338 Consecutive Patients. Surgery, 146, 1048-1055. [Google Scholar] [CrossRef] [PubMed]
[57] Chen, Y., Kim, H., Anuwong, A., Huang, T. and Duh, Q. (2020) Transoral Robotic Thyroidectomy versus Transoral Endoscopic Thyroidectomy: A Propensity-Score-Matched Analysis of Surgical Outcomes. Surgical Endoscopy, 35, 6179-6189. [Google Scholar] [CrossRef] [PubMed]
[58] Dhahri, A.A., Ahmad, R., Rao, A., Bhatti, D., Ahmad, S.H., Ghufran, S., et al. (2021) Use of Prophylactic Steroids to Prevent Hypocalcemia and Voice Dysfunction in Patients Undergoing Thyroidectomy: A Randomized Clinical Trial. JAMA OtolaryngologyHead & Neck Surgery, 147, Article No. 866. [Google Scholar] [CrossRef] [PubMed]
[59] 贺青卿, 朱见, 王丹, 等. 机器人甲状腺及甲状旁腺手术中神经电生理监测临床操作专家共识(2019版) [J]. 中国实用外科杂志, 2019, 39(12): 1248-1253.
[60] Park, J. and Kim, K. (2024) Current and Future of Robotic Surgery in Thyroid Cancer Treatment. Cancers, 16, Article No. 2470. [Google Scholar] [CrossRef] [PubMed]
[61] Materazzi, G., Papini, P., Fregoli, L., Morganti, R., De Palma, A., Ambrosini, C.E., et al. (2023) The Learning Curve on Robot-Assisted Transaxillary Thyroidectomy Performed by a Single Endocrine Surgeon in a Third-Level Institution in Europe: A Cumulative Sum (CUSUM) Analysis. Updates in Surgery, 75, 1653-1660. [Google Scholar] [CrossRef] [PubMed]
[62] 孙寒星. 机器人甲状腺切除手术学习曲线: 单个术者的研究[J]. 外科理论与实践, 2019, 24(4): 320-324.