Robotic thyroidectomy and neck dissection: past, present, and future

The advantages of endoscopic thyroidectomy and neck dissection include reduced hyperesthesia or paresthesia in the neck and favorable cosmetic outcomes. However, endoscopic thyroidectomy with neck dissection has a long learning curve, as well as technical limitations associated with a 2-dimensional view and a reduced dexterity of movement, particularly when operating in deep and narrow spaces such as the neck area. A robotic approach has been developed to overcome these limitations, facilitating manipulation and shortening the learning curve. This system enables the surgeon to control the 3-dimensional high-definition camera, reducing physiological tremors and enabling free dexterity of movement using articulated instruments. Therefore, robotic surgery has been found to eliminate many problems encountered with conventional endoscopic techniques.Recently, robotic thyroidectomy with neck dissection via a gasless transaxillary approach was shown to yield similar oncologic outcomes as conventional open procedures, as determined by postoperative radioactive iodine scans, serum thyroglobulin concentrations, and number of retrieved cervical lymph nodes. We also found that the robotic technique was safe and feasible in thyroid cancer patients, yielding excellent cosmetic results, reduced pain, improved sensory changes and decreased postoperative voice changes and swallowing discomfort. For surgeons, the use of a robot offers a shorter operation time and the need for a shorter learning curve than conventional endoscopic thyroidectomy. Robotic thyroidectomy also causes less musculoskeletal discomfort to surgeons than open or endoscopic thyroidectomy. The advantages of robotic surgery over open or endoscopic surgery suggest that robotic thyroidectomy with neck dissection may become the preferred surgical option for patients with thyroid cancer. Further analyses of surgeons' experience, assessments of long-term outcomes, and randomized controlled trials remain important.