韩国机器人甲状腺手术发展现状、争议与未来展望OA

Over the past two decades,robotic thyroid surgery has developed rapidly in South Korea.The Korean experience has not represented a linear evolution of a single technique;rather,it has been characterized by the parallel development and continuous refinement of multiple remote-access approaches.Representative approaches include the gasless transaxillary approach,the bilateral axillo-breast approach(BABA),and more recently,single-port techniques such as the one-port areolar approach(OPAA).Among the various remote-access approaches,BABA has become one of the most highly standardized and reproducible techniques because of its symmetric operative field,operative ergonomics similar to those of the conventional midline approach,and favorable applicability to bilateral thyroidectomy.Based on nationwide claims data from the Korean Health Insurance Review and Assessment Service(HIRA)from 2006 to 2022 and data from the 2024 Intuitive Surgical Korean registry,the proportion of robotic thyroidectomy among all thyroidectomies in South Korea increased from 0.03％in 2006 to 12.75％in 2022.By 2024,a total of 203 da Vinci surgical systems had been installed in South Korea,and thyroidectomy accounted for 92.0％of all robotic head and neck procedures.In 2024,the distribution of robotic thyroidectomy approaches was as follows:transaxillary approach,38.0％;BABA,35.7％;retroauricular approach,21.8％;and transoral approach,4.5％.Single-port procedures accounted for 34.0％,representing a marked increase from 3.0％in 2018.The adoption rate of robotic surgery was highest among young women aged 20-39 years,and by 2022 this group accounted for 24.9％.In appropriately selected patients,the major approaches have oncologic outcomes comparable to those of conventional open thyroidectomy.Overall,the development of robotic thyroid surgery in South Korea reflects the coexistence and complementarity of multiple remote-access approaches in a mature stage of evolution:BABA provides a standardized platform with a symmetric operative field for bilateral procedures and is conducive to broader dissemination,whereas single-port approaches further explore the possibility of reducing surgical invasiveness on this basis.Future progress will continue to depend on ongoing technical refinement,structured training systems,and strict patient selection,supported by data from high-volume centers.