Robotic versus open thyroidectomy with neck dissection: A cohort comparison of safety, efficacy and radioiodine therapy

The efficacy of robotic surgery, particularly for thyroidectomy with LND, remains controversial. The dynamic risk assessment system using 131I whole-body scintigraphy (WBS) can detect small residual thyroid tissue and lesions following surgery for DTC. Therefore, it serves as a valuable tool for evaluating the surgical completeness and efficacy of RT or OT with LND. To assess the efficacy and safety of robotic thyroidectomy (RT) with lateral neck dissection (LND) versus open thyroidectomy (OT) + LND for differentiated thyroid cancer (DTC). This retrospective cohort study included 1010 differentiated thyroid cancer patients from 2019 to 2023. Following propensity score matching (1:3 ratio), 408 patients who underwent OT or RT with LND were analyzed. Postoperative complications, surgical completeness, which were assessed using a dynamic risk system incorporating 131 I-whole-body scans ( 131 I-WBS) and Radioactive iodine (RAI) efficacy evaluation. By incorporating 131 I-WBS into dynamic risk assessment, the evaluation results of the two groups were significantly changed (P < .01). There were no significant differences in the 3h iodine uptake rate and 99m TcO 4 − thyroid imaging between the two groups (( P > .05). Additionally, the dynamic risk assessment evaluated at the time of RAI and six months after RAI did not significantly differ between the two groups ( P > .05). The rates of transient and permanent hypoparathyroidism were higher in the OT group than in the RT group ( P < .05). The permanent hoarseness, transient hypocalcemia, recurrence, and metastasis rates showed no significant difference between the two groups ( P > .05). This study is the first to demonstrate that, by incorporating the 131 I-WBS dynamic evaluation system, RT with LND via the BABA approach can achieve surgical completeness and efficacy comparable to open surgery, while maintaining neck aesthetics.