单孔经腋窝中线入路机器人甲状腺切除术（SMART-甲状腺切除术）：技术描述及首例系列可行性评估
Single-port, via a midline approach, Robotic Transaxillary Thyroidectomy (SMART-Thyroidectomy): description of the technique and evaluation of feasibility in the first case series.
文献信息
| PMID | 42758263 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Marco Raffaelli |
| 作者单位 | UOC di Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, 00168, Italy. marco.raffaelli@unicatt.it. |
| 期刊 | Journal of robotic surgery |
| SCI 分区 | Q1 |
| IF | 3.8 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
达芬奇SP系统最近被应用于远程入路机器人甲状腺切除术，实现了单孔（SP）手术并增强了器械关节活动度。我们评估了一种新型单切口、经中线入路、机器人经腋窝甲状腺切除术（SMART-T）的可行性，该术式结合了隐蔽腋窝切口的美容优势与双侧腋窝-乳房入路（BABA）所提供的双侧中线暴露。对2026年6月至7月期间接受SMART-T的初始系列患者进行了前瞻性分析。收集了人口统计学、手术、病理和术后数据。16例患者成功接受SMART-T，无中转。所有患者均行腺叶-峡部切除术（11例右侧，5例左侧）。平均手术时间为99.6±17.5分钟，平均对接和控制台时间分别为5.1±2.0分钟和55.6±17.7分钟。3例患者完成了同侧中央颈清扫。1例患者出现短暂轻微声带活动减弱，7天内恢复。无其他并发症发生。术后疼痛和镇痛需求极小。主观嗓音和吞咽障碍轻微，至术后第7天完全恢复。87.5%的患者将美容效果评为极好。本研究报道了欧洲首个SP BABA衍生甲状腺手术的临床系列。SMART-T是一种可行的单孔机器人甲状腺切除术式，通过单个腋窝切口提供类似BABA的中线手术视野，早期手术、功能和美容结果令人鼓舞，支持在更大规模、更长随访的研究中进一步评估。
英文摘要
The Da Vinci SP system has recently been applied to remote-access robotic thyroidectomy, enabling single-port (SP) surgery with enhanced instrument articulation. We evaluated the feasibility of a novel Single-incision, via a Midline Approach, Robotic Transaxillary Thyroidectomy (SMART-T), which combines the cosmetic advantages of a concealed axillary incision with the bilateral midline exposure provided by the bilateral axillo-breast approach (BABA). A prospective analysis was performed on an initial series of patients who underwent SMART-T between June and July 2026. Demographic, operative, pathological, and postoperative data were collected. Sixteen patients successfully underwent SMART-T without conversion. All patients underwent lobo-isthmusectomy (11 right-sided and 5 left-sided procedures). Mean operative time was 99.6 ± 17.5 min, with mean docking and console times of 5.1 ± 2.0 and 55.6 ± 17.7 min, respectively. Ipsilateral central neck dissection was completed in three patients. One patient experienced transient minimal vocal cord hypomobility that resolved within 7 days. No other complication occurred. Postoperative pain and analgesic requirements were minimal. Subjective voice and swallowing impairment were minimal and completely recovered by postoperative day 7. Cosmetic outcomes were rated as excellent by 87.5% of patients. The present study reports the first European clinical series of SP BABA-derived thyroid procedures. SMART-T is a feasible single-port robotic approach to thyroidectomy that provides a BABA-like midline operative view through a single axillary incision, with encouraging early operative, functional, and cosmetic outcomes that support further evaluation in larger studies with longer follow-up.