Kyung Tae1, Jin Ye Yeo2
1Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea; 2GS Editorial Office, AME Publishing Company
Correspondence to: Jin Ye Yeo. GS Editorial Office, AME Publishing Company. Email: editor@glandsurgery.org
Expert introduction
Dr. Kyung Tae (Figure 1) is a professor of Otolaryngology-Head and Neck Surgery at Hanyang University in Seoul, Republic of Korea. He is also the founder and Director of the Asia-Pacific Society of Thyroid Surgery (APTS) and the Director of Hanyang University Hospital Cancer Center. He served as the Chairman of the Board of Directors of the Korean Society of Otorhinolaryngology-Head and Neck Surgery in 2014-2015 and vice president of the Korean Thyroid Association in 2016-2017. Dr. Tae also served as general secretary of the Korean Society of Thyroid, Head and Neck Surgery and the Korean Society of Head and Neck Oncology.
His primary clinical and research interests include thyroid/parathyroid surgery, especially robotic and endoscopic thyroid surgery, and head and neck oncology. He is an expert on robotic thyroid and head and neck surgery. He has published more than 350 articles in peer-reviewed journals and book chapters.
Figure 1 Dr. Kyung Tae
Interview
GS: What motivated you to pursue thyroid surgery among all the other fields in surgery?
Dr. Tae: I had dreamed of becoming a great surgeon since I was a medical school student. While trying to figure out what kind of surgeon I would like to be, I decided to become a head and neck surgeon. I chose this field because head and neck surgery and oncology are very complex and related to various human functions, and this field was significantly expanding and developing in Korea when I was a medical student. Of various head and neck cancers, thyroid cancer has an excellent prognosis. Most patients are satisfied after surgery, and doctors can find it rewarding. Thus, I became very interested in this field and decided to major in it. In particular, I am a head and neck surgeon with residency training in otolaryngology. I chose to specialize in this field because the postoperative outcome and quality of life for thyroid cancer were better than for other head and neck cancers. In addition, as the incidence of thyroid cancer has increased rapidly in Korea, interest and demand among doctors have also increased, which further fuelled the interest in me. Having performed thyroid cancer surgery for over 30 years, I find it very rewarding as a surgeon.
GS: How did your research interest in robotic and endoscopic aspects of thyroid surgery come about?
Dr. Tae: In the treatment of thyroid cancer, various minimally invasive surgeries were attempted to reduce surgical morbidity and improve postoperative cosmesis, as in another surgical field. I am always interested in improving postoperative outcomes, so my interest goes to remote-access thyroidectomy. With the advent of the da Vinci robot, significant progress has been made in this area. The da Vinci robot was installed first at our hospital in 2008. In remote-access robotic and endoscopic thyroid surgery, research on the effectiveness and significance of this procedure has yet to be established. Therefore, I began research in this field to determine this procedure's exact importance and role.
GS: Could you provide an overview of the current landscape of publications in robotic and endoscopic thyroid surgery?
Dr. Tae: Remote-access robotic and endoscopic thyroidectomy gained popularity over the past 25 years to hide neck scarring via cervical, axillary, anterior chest, breast, retroauricular, or transoral incisions. Of various remote access thyroidectomies, the transaxillary, bilateral axillo-breast approach (BABA), retroauricular, and transoral approaches are commonly used today. The transoral approach is becoming popular and adopted in many institutes worldwide due to the advantages of less surgical morbidity and excellent cosmesis.
The number of articles on the transoral approach has abruptly increased since 2020, reaching 100 articles annually, while articles on other approaches have remained the same. This might reflect the popularity and growing rate of adoption of this approach.
GS: Are there any recent advancements in robotic and endoscopic thyroid surgery that you think hold significant promise?
Dr. Tae: Each of the four standard remote-access procedures, including the transaxillary, BABA, retroauricular, and transoral approaches, has advantages and disadvantages.
The gasless transaxillary approach provides an excellent surgical view of the thyroid gland and the lateral neck compartment. Total thyroidectomy and central neck dissection are feasible through a unilateral axillary incision when performed by experienced surgeons. However, dissection of the contralateral thyroid lobe and identifying the recurrent laryngeal nerve (RLN) is tricky because of the limited visualization of the contralateral side from a unilateral incision.
The gasless retroauricular approach requires a smaller dissection area to reach the thyroid gland than the transaxillary and BABA approaches. This approach allows comprehensive lateral neck dissection, including levels II-V. Postoperative cosmesis is acceptable, although postauricular scars tend to be hypertrophied compared to conventional incisions. The main drawbacks of this approach are the very narrow working space and the difficulty of approaching the contralateral side via a unilateral incision. Therefore, this approach is usually limited to thyroid lobectomy.
The BABA has superior cosmetic outcomes. Total thyroidectomy and bilateral lateral neck dissection are feasible. However, the invasiveness needed for working space is higher. Most women do not prefer areolar incisions.
Transoral thyroidectomy has several advantages and is considered a game-changer in remote-access thyroidectomy. The transoral approach is less invasive in creating a working space than other remote-access thyroidectomies. This approach enables surgeons to perform bilateral total thyroidectomy and central neck dissection. Postoperative cosmesis is better than other procedures because there is no visible neck skin scar.
The most significant advantage of remote-access thyroidectomy is superior cosmetic outcomes. The transoral approach showed the highest cosmetic results of these three methods, followed by the transaxillary and retroauricular approaches.
GS: According to your expertise and experience in robotic and endoscopic thyroid surgery, what specific areas or aspects of remote-access thyroid surgery research do you believe have been overlooked or received insufficient attention?
Dr. Tae: Oncologic outcome is crucial in thyroid cancer surgery. Oncologic outcomes and safety should not be overlooked in remote-access thyroidectomy for thyroid cancer in favor of cosmetic outcomes. Several studies showed no significant cancer recurrence rate between the remote-access and conventional approaches. A meta-analysis study showed the overall recurrence rates were 1.31% for the traditional method, 0.89% for the gasless transaxillary approach, 0.62% for BABA, and 0% for the transoral approach, with no significant differences in recurrence rates adjusted for follow-up duration. Remote-access thyroidectomy is usually applied for small-sized, low-risk papillary thyroid carcinoma (PTC). The prognosis of low-risk PTC is excellent regardless of the surgical approach and extent of surgery. Therefore, the oncologic safety of remote-access thyroidectomy might be acceptable for low-risk PTC. However, further research should clarify the oncologic safety of remote-access thyroidectomy based on the long-term follow-up results.
GS: Moving forward, what do you think should be the direction of robotic and endoscopic thyroid surgery research? Could you share any ongoing projects you are currently involved in?
Dr. Tae: In remote-access thyroid surgery, postoperative functional outcomes of voice and swallowing are also important issues. Regarding the postoperative voice outcomes, some studies showed similar voice handicap index and voice quality between the remote-access and conventional methods. However, some studies demonstrated better voice outcomes after remote-access thyroidectomy, including transaxillary, retroauricular, and transoral approaches, and significantly better preservation of the highest frequency in the remote-access approach. In addition, swallowing impairment is reported to be similar to that of remote-access and conventional approaches. Further studies are needed to clarify these results. I am evaluating the voice and swallowing outcomes after transoral robotic thyroidectomy to determine them well.
GS: How has your experience been as an Editorial Board Member of GS?
Dr. Tae: I am pleased to be involved in the Editorial Board of GS. I want to contribute to the development of GS as an Editorial Board Member.
GS: As an Editorial Board Member of GS, what are your expectations for GS?
Dr. Tae: The journal’s name, Gland Surgery, is well-chosen. I am pleased that it covers all glandular diseases, with the thyroid gland being a critical area. I am watching many interesting articles being submitted to the GS. I expect that the GS will develop and progress to become the top journal in the field of gland surgery.