Abstract
Objective: Robot-assisted neck dissection (ND) in papillary thyroid carcinoma (PTC) patients with lateral neck metastasis was proven to be feasible. However, approaches for upper neck levels are restricted. Thus, we designed novel approach for robotic ND to cover upper neck levels in PTC patients using transaxillary and retroauricular (TARA) incisions. Method: Between January 2011 and October 2011, 11 patients underwent total thyroidectomy and comprehensive neck dissection using a da Vinci surgical robotic system via TARA incisions. Results: In all cases, successful comprehensive NDs via TARA incisions using robotic surgical system could be performed. Axis change of robot was unnecessary to align the robotic arms and endoscope for upper neck levels. Vital structures including major vessels and nerves were preserved. No perioperative complications were developed. The numbers of retrieved lymph nodes in robotic neck dissections were comparable with those in conventional neck dissections. Conclusion: A robotic ND via a TARA approach to PTC patients with cervical lymph node metastasis was performed successfully. This new approach provides advantages especially in the dissection of levels IIb and V. This is a useful, alternative approach for addressing cervical lymph node metastasis in selected cases of PTC. Long-term outcomes of robotic ND should be accumulated to determine the oncologic safety.
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