Abstract
Background: Bilateral axillo-breast approach (BABA) robotic thyroidectomy has been successfully performed for thyroid cancer patients with excellent cosmetic results. Completion thyroidectomy is sometimes necessary after thyroid lobectomy, and whether it has a higher complication rate than the primary operation due to the presence of adhesions remains controversial. The aim of this study was to evaluate surgical outcomes, including operation time and postoperative complications, in patients who underwent BABA robotic completion thyroidectomy. Methods: From Jan 2012 to Aug 2020, 33 consecutive patients underwent BABA robotic completion thyroidectomy for a thyroid malignancy after BABA robotic thyroid lobectomy. The procedures were divided into five steps: (1) robot setting and surgical draping, (2) flap dissection, (3) robot docking, (4) thyroidectomy, and (5) closure. Clinicopathological characteristics, operation time, and postoperative complications were reviewed. Results: The total operation time was shorter for completion thyroidectomy than for the initial operation (164.8 ± 31.7 min vs. 179.8 ± 27.1 min, p = 0.043). Among the robotic thyroidectomy steps, the duration of the thyroidectomy step was shorter than that of the initial operation (69.6 ± 20.9 min vs. 83.0 ± 19.5 min, p = 0.009. One patient (1/33, 3.0%) needed hematoma evacuation under the flap area immediately after surgery. Three patients (3/33, 9.1%) showed transient hypoparathyroidism, and one patient (1/33, 3.0%) had permanent hypoparathyroidism. Two patients (2/33, 6.1%) showed transient vocal cord palsy and recovered within 3 months following the completion thyroidectomy. There were no cases of open conversion, tracheal injury, flap injury or wound infection. Conclusions: BABA robotic completion thyroidectomy could be performed safely without completion-related complication.
Highlights
Given the desire to avoid visible anterior neck scars after conventional open thyroidectomy, remote access thyroid surgery has been introduced and developed [1,2,3]
Central lymph nodes (LNs) dissection was performed in 26 patients at the initial bilateral axillo-breast approach (BABA) thyroid lobectomy (78.8%), and 11 patients (33.3%) underwent central LN dissection when undergoing BABA RCT
To the best of our knowledge, this is the first study to evaluate the surgical safety of BABA RCT and investigate the times of the individual steps of BABA robotic thyroidectomy to estimate the surgical difficulty in performing completion thyroidectomy using BABA after BABA robotic thyroid lobectomy
Summary
Given the desire to avoid visible anterior neck scars after conventional open thyroidectomy, remote access thyroid surgery has been introduced and developed [1,2,3]. The initial experience with remote access thyroid surgery using endoscopic instruments has several limitations: restrictions in instrument manipulation, unstable camera vision, and loss of stereoscopic depth perception by using two-dimensional visualization [1,2,4]. Various approaches to remote access thyroid surgery have been developed, including the transaxillary, anterior chest, postauricular, transoral, and bilateral axillo-breast approach (BABA) [5]. The BABA is one of the most popular techniques for performing remote access thyroid surgery worldwide. Bilateral axillo-breast approach (BABA) robotic thyroidectomy has been successfully performed for thyroid cancer patients with excellent cosmetic results. The aim of this study was to evaluate surgical outcomes, including operation time and postoperative complications, in patients who underwent BABA robotic completion thyroidectomy. Conclusions: BABA robotic completion thyroidectomy could be performed safely without completion-related complication
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