Voice Change in Robotic Versus Open Thyroidectomy : Preliminary Results

Ra-Yeong Song¹, Jin Wook Yi¹, Hyeong Won Yu¹, Joon-Hyop Lee², Hyungju Kwon¹, Su-jin Kim¹, Young Jun Chai³, June Young Choi², Seong Ho Yoo⁴, Kyu Eun Lee¹. ¹Department of Surgery, Seoul National University Hospital and College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, Korea, ²Department of Surgery, Seoul National University Bundang Hospital and College of Medicine, 300 Gumi-dong, Bundang-gu, Seongnam, Korea, ³Department of Surgery, Seoul National University Boramae Medical Center, 20 Boramae-ro 5-gil, Donjak-gu, Seoul, Korea, ⁴Seoul National University Hospital, Biomedical Research Institute of Forensic Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, Korea

Introduction: Bilateral axillo-breast approach (BABA) robotic thyroidectomy (RoT) is considered safe and effective for the treatment of benign and malignant thyroid diseases, providing with excellent cosmetic outcomes. This study compares voice changes in patients receiving the BABA RoT, to conventional open thyroidectomy (OT), with a focus on the impact of superior laryngeal nerve (SLN) injury.

Methods: Of 358 patients who had undergone total thyroidectomy between February 2015 and June 2015, a total of 137 patients who had completed both preoperative and postoperative voice evaluation were included in the study. The voice evaluation protocol in our institute includes a perceptual assessment through the GRBAS (grade, roughness, breathiness, asthenia, strain) scale; electroglottography (EGG) and acoustic analysis; the aerodynamic analysis, and the voice range profile (VRP). Patients were also asked to fill out a voice questionnaire that includes the voice handicap index-10 (VHI).

Results: 32 (23.4%) patients underwent BABA RoT, and 105 received OT. Patients in the BABA RoT group were younger than those in the OT group (39.56 ± 10.32 years vs. 48.85 ± 12.57, p<0.001). Both groups did not differ in gender, final pathologic diagnosis, and tumor size. There were no significant differences in preoperative self-assessment score (VAS), GRBAS, VHI-10 and VRP. There were significant decreases in VAS and VRP, and increases in GRBAS and VHI-10 during evaluation performed two weeks postoperatively in both groups. The amount of change was lower in BABA RoT patients, although with no statistical significance: change in VAS, 17.97 ± 19.46 vs. 23.86 ± 23.07 (p=0.193); change in GRBAS, 1.44 ± 1.48 vs. 1.69 ± 1.98 (p=0.514); change in VHI-10 score, 8.59 ± 10.73 vs. 11.0 ± 10.14 (p=0.249); change in VRP, 82.90 ± 99.94 vs. 116.51 ± 128.87 (p=0.178).

Conclusion: BABA RoT provides with a wide, symmetrical view of the bilateral thyroid lobes, as well as a better view of structures surrounding the superior pole. This enables for a clear visualization and safe dissection of the external branch of the superior laryngeal nerve (EBSLN) in most cases. The objective assessment of change in voice, and especially VRP, shows that BABA RoT can result in less voice impairment, with better preservation of the EBSLN, compared to OT. These are results of short-term changes in voice after thyroidectomy.