Thyroid cells seeding along the transaxillary approach after robot-assisted transaxillary surgery (RATS) for a benign node

Abstract

The use of robot-assisted transaxillary surgery (RATS) for the management of thyroid nodes is increasing. It has the advantage of the absence of scar, but specific complications such as injury to the brachial plexus, and risk of thyroid cells seeding along the transaxillary approach. We report the second case of benign thyroid cells seeding along the transaxillary approach and the first mimicking malignant spreading on imaging. The patient was treated for a 20 mm right follicular adenoma by RATS. Eight years later, she presented with multiple subcutaneous nodules in the supraclavicular, axillary, pectoral areas, and in the right thyroid compartment, with internal jugular vein and sternocleidomastoid muscle invasion on CT-scan. The patient was treated by open surgery. Histologically, benign thyroid tissue displacement within muscular and connective tissues was identified in all masses. Considering the multiple disseminated lesions, adjuvant treatment by radioactive iodine ablation was recommended. Surgeons performing RATS should be aware that thyroid cell seeding may occur even with benign nodes and lead to the need of secondary open surgery with scars.