Robotic Thyroidectomy via a Transaxillary Approach

Abstract

Objective: Recently, various robotic surgical procedures have been performed, and most reports have proved that the application of robotic technology for surgery is technically feasible and safe. The feasibility and safety of robotic thyroid surgery was examined via transaxillary single port approach without gas insufflation. Method: The study included 109 consecutive patients with papillary thyroid cancer who underwent robot-assisted endoscopic thyroid surgery using a gasless transaxillary single port approach by a single surgeon (Y.W.K.) between May 2010 and August 2011 at the department of otorhinolaryngology, Yonsei University College of Medicine. Results: The console time for 50 hemithyroidectomy (HT) with ipsilateral central compartment neck dissection (CCND) was 45.67 min, and that of 59 total thyroidectomy (TT) with ipsilateral or bilateral CCND was 93.77 min. The amount of drainage was 194.07 mL, and the duration of drainage was 3.5 days. The hospital stay was 6.09 days. Mean primary tumor size was 6.58 mm. The average number of lymph nodes resected was 3.51 (range, 1-19). Temporary hypoparathyroidism encountered with 24 patients in the TT group (40.7%, 24/59). There were 5 cases of temporary recurrent laryngeal nerve injury and 12 of seromas. One case of temporary brachial plexus injury occurred due to arm positioning. Conclusion: The technique of robotic thyroid surgery using a gasless transaxillary single port approach is a feasible, safe, and effective method for selected patients with thyroid cancer. The authors suggest that application of robotic technology for endoscopic thyroid surgeries could overcome the limitations of conventional endoscopic surgeries in the surgical management of thyroid cancer.