Evolution Strategies in Transaxillary Robotic Thyroidectomy: Considerations on the First 449 Cases Performed.

Area of Science:

• Endocrine Surgery
• Minimally Invasive Surgery
• Robotic Surgery

Background:

• The increasing demand for cosmetic outcomes in thyroid surgery has driven the development of remote access robotic thyroidectomy (RT).
• The unilateral transaxillary approach for RT has shown excellent feasibility and patient compliance, overcoming limitations of traditional mini-invasive techniques.
• Our institution has extensive experience with robotic and laparoscopic procedures, performing RT with a skilled endocrine surgery team.

Purpose of the Study:

• To report an 8-year single-center experience with robot-assisted thyroidectomy.
• To demonstrate the safety and feasibility of a gasless unilateral transaxillary approach using a hybrid technique.
• To evaluate outcomes compared to traditional anterior cervicotomy.

Main Methods:

• A total of 472 patients underwent transaxillary surgery between September 2010 and June 2018.
• The hybrid technique was employed for all robotic procedures, with 412 cases utilizing the Modena Retractor.
• Indications included benign lesions (<5 cm), Graves' disease, well-differentiated thyroid cancers, and parathyroid adenomas.

Main Results:

• Data from 449 registered cases were analyzed, including patient demographics, tumor characteristics, and operative details.
• Key metrics assessed were operative time and postoperative complications.
• The study focused on patient data such as gender, age, BMI, tumor size, and preoperative/definitive histological findings.

Conclusions:

• Robotic thyroid surgery, particularly with the hybrid technique, is a safe and feasible approach with a low risk of complications.
• This method achieves outcomes comparable to traditional cervicotomy while providing a scarless result.
• A dedicated surgical team is crucial for successful implementation and optimal patient outcomes.