Robotic Thyroidectomy

• Prevalence of thyroid cancer. Thyroid cancer incidence in Korea is the highest in the world and is increasing. The incidence is 2.2 times higher than in Western countries. Consequently, Han et al have provided a comprehensive picture of the first screening program for thyroid cancer in Korea with an overall screening rate of 13.2%. Screening thyroid cancer is not recommended by any organizations in Western countries. • Prevalence of microcarcinomas. Koreans have an incidence of microcarcinoma of 60%. Differently, in our clinic, the mean tumor size is 2.5 cm, and only 20% of tumors are <1 cm. • Management of papillary thyroid cancer (PTC). In a study by Lee et al, 76% patients underwent less than total thyroidectomy with ipsilateral central-compartment lymphadenectomy. Conversely, guidelines suggest total thyroidectomy and prophylactic central-compartment dissection in PTC stages T3 to T4. • Volume of specimen. Small gland volume is a prerequisite for safe execution of a robotic procedure. When reported, the average volume of the specimen is <10 mL. Differently, in our clinic, volume size is >20 mL. • Risk for hypertrophic scars. Asian studies demonstrated an incidence of neck hypertrophic scars of 77%, whereas in Europe, the incidence is lower (24%). • Sense of aesthetic. Sense of aesthetic may necessitate formulation of different approaches. The neck is considered a physically sensuous area much more in Asian cultures than in Western cultures. • Body habitus. Larger body mass index (BMI) results in a significant increase in difficulty of dissection, providing less benefit and safety for the patient to have robotics. In Korea, the percentage of those with a BMI >30 is 3.2%, whereas it is 8.5% in Italy and 30% in the United States. • Reimbursement. According to the Korean reimbursement system, endoscopic thyroidectomy draws double reimbursement, and robotic thyroidectomy attains quadruple. The current Italian diagnosticrelated group (DRG290, Grouper version 24) fee, which corresponds to €2.500, does not cover hospitalization costs for either traditional thyroidectomy or thyroidectomy with any technology. Prices for capital equipment and consumables may decline if there is more competition in the market.