Robotic modified radical neck dissection with bilateral axillo-breast approach

Area of Science:

• Surgical Oncology
• Robotic Surgery
• Head and Neck Surgery

Background:

• The Bilateral Axillo-Breast Approach (BABA) robotic thyroidectomy, established in 2008, has expanded its application to robotic modified radical neck dissection (MRND).
• BABA robotic MRND is indicated for suspicious lateral neck metastasis in well-differentiated thyroid carcinoma, excluding advanced cases with common carotid artery encasement.

Purpose of the Study:

• To evaluate the safety and feasibility of BABA robotic MRND for lateral neck metastasis in well-differentiated thyroid carcinoma.
• To compare the outcomes of BABA robotic MRND with traditional open MRND.

Main Methods:

• Surgical procedures involved flap formation followed by lateral neck dissection (levels IV, Vb to III, IIA), mirroring open MRND techniques.
• Patient demographics, tumor characteristics, retrieved lymph nodes, metastatic lymph nodes, and stimulated thyroglobulin levels were compared between robotic and open groups.

Main Results:

• No significant differences were observed in patient age, sex, BMI, or tumor size between the robotic and open MRND groups.
• Oncologic outcomes, including the number of retrieved and metastatic lymph nodes and stimulated thyroglobulin levels, showed no statistically significant differences.
• The operation time for BABA robotic MRND was longer compared to open MRND.

Conclusions:

• BABA robotic MRND presents a safe and feasible surgical option for managing lateral neck metastasis in well-differentiated thyroid carcinoma.
• Further prospective, controlled, multicenter studies are necessary to establish robotic MRND as a standard alternative and to assess its cost-effectiveness beyond cosmetic benefits.