Real Scarless Transoral Robotic Thyroidectomy Using Three Ports Without Axillary Incision

Conventional transoral robotic thyroidectomy (TORT) requires an axillary incision and additional flap dissection. This study aimed to outline the first ever experiences with TORT using three ports without axillary incision and compare the results between three-port and four-port TORT. A total of 100 consecutive patients were enrolled. The study sample comprised 47 patients who underwent four-port TORT from November 2016 to June 2017, and 53 patients who underwent three-port TORT from September 2018 to June 2019. The indication of the three-port TORT was the anterior/posterior length of the thyroid <1.8 cm and mass size <1.5 cm. Operative time (minutes) was shorter in the three-port group (166.3 ± 35.4 versus 138.5 ± 34.4, P = .005). Hospital stay (days) was also shorter in the three-port group (3.8 ± 0.4 versus 2.4 ± 0.6, P = .003). TORT using three ports yielded a higher cosmetic satisfaction (3.68 ± 0.52 versus 3.89 ± 0.30, P = .002). Postoperative complications, level of calcium, parathyroid hormone, and pain were not significantly different between the groups. Our study showed that three-port TORT was associated with a shorter operative time, hospital stay, and excellent cosmesis than the conventional four-port option. In conclusion, TORT using three ports is a comparable and an effective operation method as a real scarless operation.