Villejuif, 22nd November 2016

First in France: "scarless" robot-assisted thyroid lobectomy through a facelift incision

Gustave Roussy, largest comprehensive cancer center in Europe, announces the first robotic facelift thyroidectomy in France. The surgical robotic technique enables the surgeon to hide the surgical scar in the hairline, as for a facelift, and avoids the visible scar in the neck. These surgical interventions are performed using the newest Da Vinci Xi surgical robot. Patients are included in a prospective clinical trial, EVATAR, which objectively evaluates the surgical outcomes and patient satisfaction. This innovation is one of many offered by Gustave Roussy aiming to improve patient outcomes with the use of the surgical robot.

"The surgical robot, with long arms and a high-definition camera, enables us to remove all or part of the thyroid gland through a remote-access incision behind the ear, in the hairline. The scar hidden in the hair is the same as that of a neck lift or facelift performed for esthetic reasons. The aim of this new type of thyroid surgery is to improve the esthetic consequences of surgery and improve patient self-image, particularly because this surgery is often performed on young patients," says Dr Dana Hartl, Chief of the Thyriod Surgery Unit at Gustave Roussy and principal investigator for the EVATAR study.  
The first robot assisted facelift thyroidectomies have been performed to remove half of the thyroid containing a suspicious nodule or a small cancer. It is also possible with this technique to perform a total thyroidectomy and remove lymph nodes in the neck for cancer, avoiding the long scar normally used for this type of procedure.

// Robot-assisted thyroidectomy: Prospective evaluation of the technique

Robot-assisted thyroidectomy has been performed in Asia and, to a lesser extent, in the United States, with excellent results, but few prospective studies have been performed to definitively validate the technique in terms of complete resection for benign and malignant tumors. EVATAR, the prospective study at Gustave Roussy, aims to objectively record the outcomes of all patients undergoing robot-assisted thyroidectomy, in terms of the postoperative course (pain, scar, quality of life and patient satisfaction) and in terms of oncologic outcomes. This study proposes two different options, and each patient has the choice between an axillary thyroidectomy—in which the surgical scar is placed under the arm—or a robotic facelift thyroidectomy—in which the scar is hidden in the hair behind the ear.

Eligible patients 
The thyroid tumor cannot be more than 4 cm in diameter, and lymph nodes no larger than 10mm for patients to be eligible for this surgery at Gustave Roussy. Patients are followed up with post-operative appointments at 1, 3, 6 and 12 months.

// Other types of surgery performed with the surgical robot at Gustave Roussy

The newest surgical robot, the Da Vinci Xi, has been in use at Gustave Roussy since November 2014. This technology enables surgeons to perform gynecological, digestive, head and neck and plastic and reconstructive surgeries while improving post-operative pain, functional problems and scarring. In January 2016, the first ever mastectomy with breast reconstruction was performed without a visible scar using the surgical robot.
Gustave Roussy was able to acquire this state-of-the-art technology thanks to the financial support of the Fondation Philanthropia, its largest private donor. Patronage is an essential support for this type of investment dedicated to innovation and rarely financed by public funds. This type of partnership makes it possible to rethink the modes of support by opening the field to new collaborations.

// Thyroid cancer

The thyroid gland is located at the base of the neck, just in front of the trachea and below the larynx. The  gland has two lobes, one on each side of the trachea, and an isthmus that joins the two lobes in front of the trachea. The thyroid gland secretes hormones that are required by every organ of the body. Today, hormone replacement therapy after total thyroidectomy is generally well-tolerated with no side effects.
A thyroid nodule, contained within the thyroid gland, may be discovered by palpation or on ultrasound or other medical imaging. Thyroid nodules are very common and are benign over 90%  of the time. When diagnosed, according to the size and the characteristics on ultrasound, the benign or malignant nature of the nodule can be determined by sampling cells with a fine needle. At the "One-Stop Thyroid Clinic" at Gustave Roussy, ultrasound and nodule diagnosis is performed in one day, and treatment of the nodule, if necessary, can be rapidly organized.
Treatment of thyroid cancer requires multidisciplinary management with surgery, radioactive iodine and other techniques in nuclear medicine, chemotherapy, targeted therapy, radiation therapy and interventional radiology all collaborating to ensure the optimal management.

Gustave Roussy is a national reference center for the treatment of endocrine tumors, and the national coordinating center for the French National Cancer Institute (INCa) network called TUTHYREF in the management of refractory thyroid tumors, headed by Pr Martin Schlumberger, chief of Nuclear Medicine and Endocrine Oncology at Gustave Roussy.


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