Trans‐axillary Robotic Thyroidectomy: Avoiding the Chest Port

Abstract

Objectives: Describe modification of port placement for the four-arm technique for robotic thyroidectomy to avoid a chest incision and eliminate crowding of the working space provided by the trans-axillary incision. Methods: Description of port placement modification to avoid chest incision as well as report of two cases and appropriate literature review. Results: Placement of four arms via a trans-axillary incision requires expertise. Transitioning from a chest port for placement of the fourth arm to a single-incision surgery, avoiding a visible chest incision, can be challenging. We describe this technique and two cases of trans-axillary robotic hemithyroidectomy (TART) using a trans-axillary incision and a separate 1 cm incision in the anterior axilla, 2.5 centimeters below the trans-axillary incision, for placement of the fourth arm. This design allowed for a more ergonomic placement of the fourth arm while not compromising the working space provided by the trans-axillary incision. Additionally this port is used for surgical drain placement. Conclusions: Robot-assisted trans-axillary thyroidectomy poses several challenges in the early surgical learning curve. One roadblock to exposure and efficiency is appropriate port and arm placement. Our modification offers an alternative where a four-arm technique is made possible without a chest port and without occupying the restricted working space provided by the trans-axillary incision. Use of this inferior axillary port is cosmetically acceptable, surgically efficient, and allows avoidance of a visible chest incision for placement of the fourth arm.