An Interview with Dr. Woong Youn Chung

professor in the department of surgery and chief of the endocrine surgery division at Yonsei University College of Medicine, in Seoul, and past director of the Yonsei Robot and Minimally Invasive Surgery Center.


Medical Robotics: Is it just the learning curve that accounts for these differences?
Chung: From a Korean multicenter comparative study of differences in the learning curve between endoscopic and robotic surgery, the time requirement for overcoming the learning curve was shorter in robotic group (it was 10 to 15 cases less in the robotic group). This suggests that robotic surgery is easier to learn, and also that a well-organized training program is very important.
MR: Does it take less time now for the preparation or set up of a robotic operation, or for the operation itself?
Chung: In the beginning period, the time requirement for flab dissection was about 50 minutes, docking time was more than 20 minutes, and console time more than 80 minutes. Currently, however, the time for flab dissection is about 30 minutes, docking time less than five minutes, and console time is about 50 minutes. Briefly speaking, the total operation time for a less-than-total thyroidectomy with central lymph node dissection is less than two hours, and for total thyroidectomy with central lymph node dissection, less than two-and-a-half hours.
MR: You said there were no recurrences in the study comparing robotic to endoscopic procedures?
Chung: Papillary thyroid cancer has a mild biological behavior and a favorable prognosis. Papillary thyroid carcinoma is the most common type of thyroid malignancy. It accounts for more than 90% of all thyroid cancers.
Although the prognosis of thyroid cancer is excellent (on the basis of World Health Organization data, the 10-year survival rate is more than 90%) , there is a relatively limited indication for robotic thyroidectomy which means we exclude the highly advanced cancer patient as a candidate.
MR: Did physicians choose which patients had robotic surgery, and how?
Chung: I always explain three types of thyroid surgery (open, endoscopic and robotic surgeries) to patients. Robotic surgery is the most expensive procedure in Korea because it can not be covered by national health insurance. Patients choose.
MR: Could you tell us about your gasless approach to thyroid surgery? What is the gas used for?
Chung: We have done only the gasless trans-axillary approach. The bilateral axillo-breast approach requires the use of CO2 gas to maintaining a working space. The gasless trans-axillary approach doesn’t require the gas, because the working space can be maintained during the operation by my own Chung’s retractor.