Robotic transaxillary lateral neck dissection for thyroid cancer: learning experience from 500 cases.

Area of Science:

• Surgical Oncology
• Robotic Surgery
• Head and Neck Surgery

Background:

• Differentiated thyroid carcinoma with lateral neck lymph node metastasis necessitates aggressive surgical intervention, including lateral neck dissection.
• While robotic surgery enhances precision in thyroid cancer operations, its application in lateral neck dissections remains limited.
• This study evaluates the robotic transaxillary lateral neck dissection (RTLND) using the da Vinci system for technical feasibility, cosmetic effectiveness, and safety.

Purpose of the Study:

• To demonstrate the technical feasibility of robotic transaxillary lateral neck dissection (RTLND).
• To assess the cosmetic effectiveness of RTLND.
• To evaluate the safety and efficacy of RTLND for differentiated thyroid carcinoma with lateral neck lymph node metastasis.

Main Methods:

• Retrospective review of 500 patients diagnosed with thyroid cancer and lateral neck node metastasis who underwent RTLND from January 2008 to July 2019.
• Analysis of clinicopathologic characteristics and surgical outcomes.
• All operations were performed using the da Vinci robotic system.

Main Results:

• All 500 operations were successfully completed without conversion to open surgery.
• RTLND was performed as the primary operation in 95.2% of cases, often combined with robotic total thyroidectomy.
• A low recurrence rate of only five cases (1%) requiring further treatment was observed, with a mean operation time of 293.71 minutes.

Conclusions:

• Robotic transaxillary lateral neck dissection (RTLND) is technically feasible and safe, offering precise manipulation through robotic instruments.
• The RTLND method provides thorough, safe, and effective surgical outcomes for thyroid cancer with lateral neck metastasis.
• This minimally invasive approach offers significant cosmetic advantages in addition to its efficacy.