[인터뷰] Youngwoo Jang, Professor of Breast Endocrine Surgery, Korea University Ansan Hospital
“Much more precise and safer than open surgery, which leaves a large scar on the neck.”
“Compared to existing robotic surgery methods, the incision hole is smaller and the pain is less.”
Thyroid cancer is the most common cancer in Korea. According to data from the Central Cancer Registration Headquarters, it ranked first with 12.7% of the number of cancer cases in Korea in 2021. Thyroid cancer is often called a ‘good cancer’ because it grows slowly and does not metastasize easily, but if left untreated after it has spread to nearby organs, it can be as fatal as other cancers. Therefore, if thyroid cancer is too large, invades other organs or tissues, or has metastasized, it must be removed surgically without delay.
Thyroid cancer is characterized by occurring overwhelmingly more often in women than in men, with the ratio reaching 10:3 in Korea. The problem is that many women avoid open surgery, which involves making a large incision in the skin in the front of the neck, because the scars left behind are too large and clear after the surgery. Robotic surgery through the armpit is also quite difficult because the incision is large and visibility is difficult. Meanwhile, a new robotic surgery (GOSTA robotic surgery) that treats thyroid cancer through a small 2cm hole in the armpit has emerged and is attracting attention.
We asked Jang Young-woo, a professor of breast endocrine surgery at Korea University Ansan Hospital, who developed the GOSTA robot surgery, which is safer and more precise, but with much less scarring and pain, and has already succeeded hundreds of times, about the differences and special advantages of this surgery and other surgical methods. Professor Jang said, “It is a great honor that GOSTA robotic surgery has recently been receiving a lot of attention in domestic and international academic societies, but it is unfortunate that many patients are still unaware of it.” The following is a Q&A with Professor Jang.
Thyroid cancer has no symptoms and no cause.
![‘GOSTA Robotic Surgery’, eliminates thyroid cancer with just a 2cm hole in the armpit! [건강 기상청 : 첨단 의술의 현장]](https://dimg.donga.com/wps/NEWS/IMAGE/2024/11/26/130496793.1.jpg "‘GOSTA Robotic Surgery’, eliminates thyroid cancer with just a 2cm hole in the armpit! [건강 기상청 : 첨단 의술의 현장]")
What kind of disease is thyroid cancer?
“The thyroid gland is a butterfly-shaped organ in the front of the neck that secretes thyroid hormones that regulate metabolism. “The malignant tumor that develops there is called thyroid cancer.”
What is the most common thyroid cancer?
“Thyroid cancer is largely divided into papillary cancer and follicular cancer, and most of them are papillary cancer. Both have slow metastasis and good prognosis. “Medullary cancer and undifferentiated cancer, which occur rarely, have a relatively poor prognosis.”
What are the symptoms?
“There are almost no symptoms until it grows to a certain extent. If cancer cells grow a lot, a hard lump may be felt on the front of the neck. “Symptoms such as hoarseness and fatigue are rare symptoms that can occur only when thyroid cancer is at an advanced stage.”
What are the causes and prevention?
“In rare cases, it can be caused by radiation exposure, genetics, etc., but in most cases, the cause is unknown. “Because there are no specific symptoms or preventive measures, early detection is most important, including regular ultrasound examinations that do not cause radiation harm.”
Can the diagnosis be confirmed by ultrasound?
“If cancer is suspected based on ultrasound, a fine needle aspiration test is performed where tumor cells are sucked out using a very thin needle and their appearance is examined. Sometimes, when it is impossible to identify a tumor with a fine needle aspiration test, a core needle biopsy is performed, in which the tumor tissue is removed with a thick needle. “The thyroid gland has a lot of blood flow and is attached to structures that are fatal when damaged, such as the airway, carotid artery, and jugular vein, so this test is always performed last.”
What is the typical treatment for thyroid cancer?
“The basic treatment for thyroid cancer is surgery, which is physical removal. “Radioactive iodine treatment is often performed to prevent recurrence after total thyroidectomy, and when the cancer is advanced and surgery is difficult, external radiation irradiation and chemotherapy are performed.”
What are the criteria for removing one or both thyroid glands?
“If the cancer size is small and metastasis to nearby lymph nodes is not confirmed in the preoperative examination, hemithyroidectomy, in which only one thyroid gland is removed, is usually performed. On the other hand, if there is malignant tumor in both thyroid glands, if the cancer size is large, if metastasis to other organs such as lymph nodes around the thyroid gland is confirmed during preoperative examination, if it invades surrounding muscles or tissues, if there are multiple cancers in the thyroid gland, etc. Total thyroidectomy is performed to remove both sides. On the other hand, if thyroid cancer has progressed and spread to the lymph nodes on the side of the neck (lateral cervical lymph nodes), total thyroidectomy and lateral cervical lymph node dissection (one or both sides) are performed together.”
What are the major categories of surgical methods for thyroid cancer?
“It can be broadly divided into open surgery and robotic surgery. Open surgery is a surgery to remove the thyroid gland by making a 5-6cm incision in the skin at the front of the neck. If metastasis to the lymph nodes on the side of the neck is confirmed, an incision of approximately 13 to 15 cm should be made if lateral cervical lymphadenectomy is performed on one side, and an incision of approximately 25 cm should be made if lateral cervical lymphadenectomy is performed on both sides. Robotic surgery refers to a surgeon performing surgery using surgical robot instruments.”
What is the biggest advantage of robotic surgery?
“The only known advantage of robotic surgery compared to open surgery is that there is no scar on the neck. However, the biggest advantage is that it is a robotic machine with no hand tremors and a 10 times wider surgical field of view, allowing for more precise and safe surgery without damaging small nerves or blood vessels that are difficult to see with the naked eye.”
‘GOSTA robotic surgery’ performed more than 350 times
What types of robotic surgery are currently commonly used?
I heard that a new robotic surgery has been developed.
“To date, we have performed more than 600 robotic thyroid surgeries. Initially, 250 surgeries were performed using the TA method, and since early last year, more than 350 surgeries have been performed using the newly developed ‘GOSTA (Gas-insufflation One-step Single-port Transaxillary) method’. GOSTA robotic surgery is simply called ‘armpit single-hole surgery’ because the surgery is performed using a device called da Vinci SP by making a single 2cm hole in the armpit.”
What are the advantages of ‘GOSTA robotic surgery’?
“If the three robotic surgeries described above are two-step surgical methods that use a robot after creating space from the surgical incision site to the thyroid gland, ‘GOSTA robotic surgery’ uses a robot from the beginning of the surgery to create space. In this case, because even the sensory nerves under the skin can be preserved using the robot’s expanded field of view, there is very little pain after surgery. The reason for making a small incision of 2cm is not because of force, but because this single hole is sufficient for robotic surgery. “Not only hemithyroidectomy but also total thyroidectomy and lateral cervical lymphadenectomy are performed safely and precisely through a 2cm hole.”
How do you compare it to open surgery?
“Generally, open surgery leaves a 6-8cm scar, and when total thyroidectomy and lateral cervical lymphadenectomy are performed together, a 15cm scar is left, but GOSTA robotic surgery only makes a 2cm hole in the armpit and allows for a safer and more precise surgery, making it possible for young people to Satisfaction among female thyroid cancer patients is very high. Perhaps that is why patients from all over the country come to receive this surgery.”
It is said that in 2025, Korea University Ansan Hospital will challenge for the ‘Epicenter’ designation by Intuitive, a world-class robotic surgery device manufacturer, with GOSTA robotic surgery.
“GOSTA robotic surgery can cleanly perform large thyroid cancer surgeries through small incisions in the armpit, so the surgical method has been presented several times at domestic and international academic conferences, and other university hospitals are also very interested and come to observe the surgery. ‘EpiCenter’ selects hospitals that meet Intuitive’s qualifications, such as proficiency in operating robotic surgery devices and the number of cumulative surgeries, and provides surgical observation and education to medical staff from around the world. Compared to the restaurant industry, it is like receiving a star rating from the Michelin Guide. There are very few institutions worldwide that have been designated as Epicenters. If our hospital is designated as an epicenter, our surgical method materials will be supplied as standard not only to domestic doctors but also to foreign doctors who want to learn GOSTA robotic surgery, and they will visit Korea University Ansan Hospital to learn the surgical method in person.”
How does the GOSTA method enhance precision during thyroid surgery?
Rgery only requires a 2cm incision made in the armpit. This significantly minimizes scarring and aesthetic concerns for patients. Moreover, because the GOSTA method utilizes the robot from the beginning of the procedure, it allows for enhanced precision in locating and preserving important anatomical structures, such as nerves and blood vessels, leading to reduced post-operative pain and quicker recovery.
In comparison to traditional open surgery, which necessitates larger incisions and thus a greater risk of complications and longer recovery times, GOSTA robotic surgery offers an advanced, minimally invasive alternative. Open surgery typically results in a healing period that can vary significantly, while patients undergoing GOSTA surgery often experience less discomfort and a faster return to normal activities.
the special advantages of GOSTA robotic surgery include:
- Minimized Scarring: The small incision (2cm) results in minimal visible scarring compared to the larger incisions required for open surgery.
- Enhanced Precision: The robotic system provides a wider field of view and eliminates hand tremors, allowing surgeons to perform intricate maneuvers with greater accuracy.
- Reduced Pain and Faster Recovery: Due to the preservation of sensory nerves and smaller incision size, patients typically report less pain post-surgery and a quicker recovery period.
- Versatility: GOSTA robotic surgery can effectively perform various types of thyroid procedures, including hemithyroidectomy, total thyroidectomy, and lateral cervical lymphadenectomy, all through the same small incision.
- Increased Patient Safety: The advanced visualization and precision of robotic surgery reduce the risk of damaging vital structures in the neck.
GOSTA robotic surgery represents a significant advancement in the treatment of thyroid cancer, offering patients a safer and more comfortable surgical option.