Robot-assisted Transaxillary Surgery Research Articles

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

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.

Outcomes of Minimally Invasive Thyroid Surgery - A Systematic Review and Meta-Analysis.

PurposeConventional thyroidectomy has been standard of care for surgical thyroid nodules. For cosmetic purposes different minimally invasive and remote-access surgical approaches have been developed. At present, the most used robotic and endoscopic thyroidectomy approaches are minimally invasive video assisted thyroidectomy (MIVAT), bilateral axillo-breast approach endoscopic thyroidectomy (BABA-ET), bilateral axillo-breast approach robotic thyroidectomy (BABA-RT), transoral endoscopic thyroidectomy via vestibular approach (TOETVA), retro-auricular endoscopic thyroidectomy (RA-ET), retro-auricular robotic thyroidectomy (RA-RT), gasless transaxillary endoscopic thyroidectomy (GTET) and robot assisted transaxillary surgery (RATS). The purpose of this systematic review was to evaluate whether minimally invasive techniques are not inferior to conventional thyroidectomy.MethodsA systematic search was conducted in Medline, Embase and Web of Science to identify original articles investigating operating time, length of hospital stay and complication rates regarding recurrent laryngeal nerve injury and hypocalcemia, of the different minimally invasive techniques.ResultsOut of 569 identified manuscripts, 98 studies met the inclusion criteria. Most studies were retrospective in nature. The results of the systematic review varied. Thirty-one articles were included in the meta-analysis. Compared to the standard of care, the meta-analysis showed no significant difference in length of hospital stay, except a longer stay after BABA-ET. No significant difference in incidence of recurrent laryngeal nerve injury and hypocalcemia was seen. As expected, operating time was significantly longer for most minimally invasive techniques.ConclusionsThis is the first comprehensive systematic review and meta-analysis comparing the eight most commonly used minimally invasive thyroid surgeries individually with standard of care. It can be concluded that minimally invasive techniques do not lead to more complications or longer hospital stay and are, therefore, not inferior to conventional thyroidectomy.

Robot-Assisted Transaxillary Surgery for Thyroid Cancer Using A Gasless Unilateral Approach: A Safe and Effective Alternative to Conventional Surgery

Robot-Assisted Transaxillary Surgery for Thyroid Cancer Using A Gasless Unilateral Approach: A Safe and Effective Alternative to Conventional Surgery

Operative Technique for Single Incision Robot-Assisted Transaxillary Thyroid Surgery

ABSTRACT During the past five years, transaxillary approaches to thyroid surgery have been introduced into surgical literature. These techniques were initially performed using traditional endoscopy, and most recently with a surgical robot. This manuscript describes our approach to robotassisted transaxillary surgery (RATS) for thyroidectomy using a single axillary incision. Because of the steep learning curve, this procedure is best implemented with a team approach. The ideal team consists of a console surgeon who operates the robot, a bedside surgeon who assists with retraction and troubleshoots robotic arm collisions and a circulating assistant who helps optimize the efficiency of the operation.

Robot assisted transaxillary surgery (RATS) for the removal of thyroid and parathyroid glands

Robotic assisted transaxillary surgery (RATS) is a minimally invasive approach for the removal of the thyroid and/or parathyroid glands through the axilla. This anatomically directed technique, popularized by Chung, eliminates a visible scar and affords excellent high definition optics of the cervical anatomy. We report an initial series of single access RATS in the U.S. The prospective endocrine surgery database at a tertiary care center was used to capture all patients who underwent RATS between October 2009 and March 2010. All procedures were performed using a single transaxillary incision. Fourteen operations were performed on 13 patients. Indications for RATS were indeterminate thyroid nodules in 11 patients, the need for completion thyroidectomy in 1 patient, and primary hyperparathyroidism in 2 patients. For patients who underwent robotic assisted thyroid lobectomy, the median thyroid nodule size was 2.1 cm (range, 0.8-2.8 cm), and the median body mass index was 25.33 (range, 21.3-34.4). Mean and median total operative times for robotic assisted thyroid lobectomies were 142 minutes and 137 minutes respectively (range, 113-192 minutes). Operative time for the 2 patients who underwent robotic assisted parathyroidectomy was 115 and 102 minutes. Minor complications occurred in 4 patients (28.5%), with no significant perioperative morbidity or mortality. RATS is feasible. We believe that further study of the RATS technique for removing thyroid lobes and parathyroid glands is warranted. This initial series suggests that careful, continued investigation is necessary prior to routine implementation into clinical practice across the U.S.