Comparative study of surgical outcomes and quality of life between endoscopic and robotic thyroidectomy for differentiated thyroid cancer patients

Background: Robotic and endoscopic thyroidectomy have increasingly been performed for patients with differentiated thyroid cancer (DTC). However, the advantages of robotic surgery over endoscopic surgery remain enigmatic, hence, the controversy about which is the optimal minimally-invasive surgery is hotly debated. This study compared the surgical outcomes and health-related quality of life (HRQOL) between robotic and endoscopic thyroidectomy in DTC patients. Methods: This study included 1,476 DTC patients, divided into endoscopic (n = 698) and robotic groups (n = 778). The patients were further subdivided into those undergoing total thyroidectomy (TT) and thyroid lobectomy (TL). Considering the differences in baseline characteristics among patients undergoing TL, propensity score matching (PSM) was performed. Intraoperative outcomes, postoperative outcomes, follow-up results, and HRQOL were compared between the two groups. Results: The operation time was longer in the endoscopic group compared to the robotic group for both TT and TL ( P < 0.05). The robotic group also had a higher number of dissected lymph nodes, lower incidence of parathyroid gland mis-resection, and smaller changes in parathyroid hormone levels ( P < 0.05). For TT patients, the robotic group exhibited a lower incidence of transient and permanent hypoparathyroidism ( P < 0.05). Over 32 months of follow-up, there was a significant difference in postoperative serum thyroglobulin levels (1.70 ± 3.50 vs 0.35 ± 1.81, P < 0.001). One patient in the robotic group developed lung metastasis, while four experienced local or regional recurrence in the endoscopic group. Patients undergoing robotic TT reported significantly better thyroid cancer-specific QOL and less fear of disease progression compared to those undergoing endoscopic TT. Conclusions: Robotic thyroidectomy offers significant advantages for DTC patients over endoscopic thyroidectomy, particularly in TT procedures.