Robotic Hemithyroidectomy: Surgery, Procedure, Risks and Benefits

Robotic Hemithyroidectomy is a procedure to remove half of the thyroid gland through automated technology using robots. These robotic arms are used to remove half of the affected thyroid gland. 

Anatomy and physiology of thyroid gland

The thyroid is a gland situated at the base of the neck. It is a butterfly-shaped gland. It comprises two lobes connected with a tissue known as the isthmus. The thyroid gland secretes the hormones thyroxine (T4) and triiodothyronine (T3) that regulate the body's metabolism. These hormones control many body functions, like heart rate, body temperature and metabolism. It is an endocrine gland that performs several vital functions. It secretes the thyroxine hormone that regulates the metabolism of the body. 

Generally, robotic hemithyroidectomy is done by a doctor to help diagnose or treat thyroid conditions. A few medical conditions that use robotic hemithyroidectomy for treatment are:

1. Cancer: Robotic hemithyroidectomy is used to remove a small part of the thyroid gland. It is usually done when there is a tumour in the initial stage. The surgery will keep it from spreading to other parts of the body.
2. Goitre: It is a condition in which the thyroid gland gets enlarged. It is due to the thyroid gland's response to produce more thyroid hormones in the body. In this condition, the thyroid gland may appear swollen.
3. Overactive Thyroid: Additionally, surgery may be required to remove an unresponsive hyperthyroid gland.

The doctor may recommend a robotic hemithyroidectomy procedure if a person has thyroid disorders. These include cancer, a noncancerous enlargement of the thyroid (goitre) and overactive thyroid (hyperthyroidism). Robotic hemithyroidectomy may also be an option if someone doesn’t get relief from non-surgical treatments.

Robotic Hemithyroidectomy mostly uses the Robotic-Assisted Transaxillary thyroid Surgery (RATS) approach. RATS is a safe alternative treatment for low-risk patients with thyroid cancer and provides enhanced cosmetic results. The Robotic hemithyroidectomy through RATS is performed through the following steps:

1. The surgeon instructs the patient to lie down on the back.
2. The surgery is performed under general anaesthesia.
3. The surgeon controls the robotic arms from the console by visualising the tissues on the monitor.
4. The surgeon makes a few incisions at the axilla. The incision is about 4-6 cm wide.
5. Once the thyroid gland is exposed, the surgeon removes half of the thyroid gland. 
6. If the patient has multinodular or large growth, the surgeon removes the isthmus (tissue that joins both lobes of the thyroid).
7. After removing the part of the thyroid gland, the surgeon sutures the incision and seals the wound with a bandage. 

Prior to the robotic hemithyroidectomy, the doctor or the surgeon will discuss and prepare the patient for the surgery. These steps often involve:

Before Robotic Hemithyroidectomy

1. The doctor may order diagnostic tests like ultrasound, MRI, and other imaging tests. 
2. These tests help in visualising the thyroid gland in a better way. Through these tests, the surgeon can find the abnormality underlying the tumours of the tissues in the thyroid gland. 
3. The doctor may seek information from the patient about the list of medicines, including ayurvedic medicines or health supplements, along with his medical history. The patient should inform the doctor about the ayurvedic medicines and health supplements.
4. The patient may also undergo a blood test. The blood test shows the amount of thyroid hormone in the patient's blood. 
5. A few days before the surgery, the patient must stop taking medicines like blood thinners before the surgery. 

On the day of Robotic Hemithyroidectomy

1. The patient would be informed about the time of the surgery. The patient should try to reach the hospital on time. 
2. When the patient reaches the hospital, he has to fill out a consent form before the surgery.
3. The hospital staff will then ask the patient to change into the surgical gown.
4. A patient ID wristband is tied to the wrist. It contains the patient's name and date of birth, along with the procedure's name.
5. An IV is injected into the arm of the patient. All the medicine is given through this IV infusion bottle. After this, the patient would be sent to the operation theatre.

The following things can be expected after the robotic thyroidectomy procedure:
 

The recovery process at the hospital

1. After the completion of the surgery, the patient is shifted to the recovery ward. All the patient's vital signs, like heart rate, breathing, and blood pressure, are monitored continuously until the patient regains consciousness.
2. The sutured incision around the neck is covered with a bandage. However, if the dressing is tight and causes difficulty breathing and swallowing, the patient should inform the doctor and the paramedical staff. 
3. Radioactive iodine may also be given to the patient to kill cancerous cells. 
4. The doctor will also provide some medicines to decrease the thyroid hormone level in the blood. The patient may also be prescribed painkillers to ease the pain after the surgery.

First follow-up appointment

1. At the first appointment with the doctor after robotic hemithyroidectomy, the doctor will examine the thyroid gland physically by touching it with the hand.
2. The doctor will also order blood tests to check the presence of the thyroid hormone in the blood.
3. If the robotic hemithyroidectomy is done to treat cancer, the patient may be called for follow-up every three months for two years.
4. This duration is increased to 6 months after two years.

There are several benefits of Robotic Hemithyroidectomy compared to conventional surgery. A lot of people choose this procedure for aesthetic purposes as there is no visible scar on the neck. Other benefits include:

1. High precision and accuracy, thereby reducing tissue damage
2. Less pain
3. No scar on the neck
4. Fewer complications post-surgery
5. Less bleeding
6. Reduced risk of infection
7. Early recovery
8. Reduced hospital stay

Robotic Hemithyroidectomy is an advanced procedure with excellent outcomes. However, there are some complications associated with Robotic Hemithyroidectomy. They are:

1. Infection
2. Bleeding
3. Numbness around the mouth
4. Post-operative pain (Cramps in feet, hands or face)
5. Decreased level of blood calcium level

When is consultation with the doctor needed?

The patients should visit the doctor if they experience any of the symptoms like:

1. Bleeding from the incision
2. Blocked airways due to bleeding
3. Difficulty in urinating (it may be due to the side effects of anaesthesia or prolonged IV fluid administration without a urinary catheter)
4. Hoarseness of voice

The Robotic Hemithyroidectomy is done to excise the part of the thyroid gland. It is done to cure different underlying medical conditions. If this surgery is delayed, then it may cause the following consequences:

1. There will be an increase in thyroid hormone in the case of goitre.
2. The patient may feel difficulty swallowing.
3. If the tumour in the neck is cancerous, then it is essential to have a Robotic Hemithyroidectomy. If it is not done, the tumours may spread to the neck and cause cancer.
4. The tumour may also cause hoarseness of voice. If not treated on time, the hoarseness becomes permanent.

The cost of robotic hemithyroidectomy ranges from ₹2,00,00 to ₹3,00,000. The cost varies based on the following factors:

Type of robotic hemithyroidectomy surgery

Age of the patient

The medical condition of the patient

The type of hospital facility availed - individual room or shared