Single-incision transaxillary robotic thyroidectomy: challenges and limitations in a North American population

Area of Science:

• Minimally Invasive Surgery
• Endocrine Surgery
• Robotic Surgery

Background:

• Robotic thyroidectomy offers a minimally invasive approach to thyroid surgery.
• Initial adoption in North America requires evaluation of its feasibility and limitations.

Purpose of the Study:

• To assess the initial experience with single-incision transaxillary robotic thyroidectomy in a North American population.
• To identify challenges and limitations of this technique in this patient demographic.

Main Methods:

• Retrospective case series of 18 consecutive robotic thyroid lobectomies.
• Performed between February 2010 and April 2012 at an academic institution.
• Included 16 female patients, with two undergoing completion thyroidectomy.

Main Results:

• The majority of procedures (94%) were completed successfully via a single axillary incision without conversion to open surgery.
• Median operative time was 170 minutes with minimal blood loss (12.5 mL).
• Complications included temporary vocal cord paresis (3 cases) and one postoperative hematoma, with a median hospital stay of 2 days.

Conclusions:

• Single-incision robotic thyroidectomy can be technically demanding in North American patients due to body frame size affecting instrument manipulation.
• Early vocal cord paresis may be linked to surgeon inexperience with the robotic system.
• Limitations include suboptimal visualization of the recurrent laryngeal nerve and restricted access to substernal regions.