Abstract
In the last decade, robot-assisted trans-axillary thyroidectomy has spread rapidly and has been proven to be a safe and effective procedure. However, several case series have reported new complications that have led to criticism regarding this approach. This study analyzed the incidence of complications in a large cohort of European patients. We enrolled all patients who underwent robot-assisted trans-axillary thyroidectomy from 2012 to 2020 at the University Hospital of Pisa Department of Endocrine Surgery. We analyzed complications and divided them into 2 groups. Group A included conventional complications, such as transient or permanent recurrent laryngeal nerve palsy, transient or permanent hypocalcemia, hemorrhage, and tracheal injury. Group B included unconventional complications, such as brachial plexus palsy, track seeding, seroma, great vessels injury, and skin flap perforation. There were 31 postsurgical complications (5.7%). Group A included 25 complications (4.6%): transient and permanent recurrent laryngeal nerve palsy occurred in 7 patients (1.3%) and in 1 (0.2%), respectively; transient and permanent hypocalcemia occurred in 9 patients (1.7%) and in 1 (0.2%), respectively. Postoperative bleeding occurred in 6 patients (1.1%) and tracheal injury in 1 (0.2%). Group B included 6 complications (1.1%): 1 patient with brachial plexus injury (0.2%), 1 with track seeding (0.2%), and 4 with seroma (0.7%). Robotic trans-axillary thyroidectomy is a safe approach with a risk of postoperative complications comparable to the conventional technique. Almost all complications after a novel introduction are anecdotal. With an accurate patient selection, high-volume institutions with experienced surgeons can perform this technique safely.
Highlights
In the last 2 decades, endoscopic procedures for thyroid surgery with alternative access to the conventional Kocher incision have spread, leading to improvements in the fields of immediate postoperative pain and cosmetic results [1–3]
Group A included conventional complications, which are defined as complications that could occur after standard open thyroidectomy, such as transient or permanent recurrent laryngeal nerve (RLN) palsy, transient or permanent hypocalcemia, hemorrhage, or tracheal injury
Group B included nonconventional complications, which are defined as complications of novel introduction mainly related to the remote access or to the position of the patient, such as brachial plexus palsy, surgical track seeding, seroma, great vessels injury, or skin flap perforation
Summary
In the last 2 decades, endoscopic procedures for thyroid surgery with alternative access to the conventional Kocher incision have spread, leading to improvements in the fields of immediate postoperative pain and cosmetic results [1–3]. All of these are characterized by the classic limitations of endoscopic surgery, including 2-dimensional (2D) view, narrow surgical space, and rigid endoscopic instruments [4, 5]. In 2007, Chung and colleagues introduced robot-assisted trans-axillary thyroidectomy (RATT) using the da Vinci robotic system [8, 9] This technique spread rapidly in Eastern countries, where thousands of procedures were performed in the following years. Its success in the Western world came more slowly as a result of various factors, including cultural and anthropometric differences [10]
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