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Robotic transaxillary thyroidectomy: time to expand indications?

Leonardo Rossi¹, Andrea De Palma², Lorenzo Fregoli²

¹Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy. rossi.leonardo.phd@gmail.com.

Journal of Robotic Surgery

|April 16, 2023

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Robotic transaxillary thyroidectomy is safe and effective, even for patients with larger thyroid nodules or thyroiditis. Outcomes are comparable to standard guidelines, demonstrating feasibility in experienced surgical hands.

Area of Science:

Endocrinology
Surgical Oncology
Minimally Invasive Surgery

Background:

The American Thyroid Association (ATA) guidelines (2016) recommend remote-access thyroid surgery for specific patient criteria: thyroid nodules ≤3 cm, thyroid lobe <6 cm, and absence of thyroiditis.
Robotic transaxillary thyroidectomy offers a minimally invasive approach, potentially improving cosmetic outcomes by avoiding a neck incision.

Purpose of the Study:

To evaluate the safety and efficacy of robotic transaxillary thyroidectomy in patients who do not meet the ATA's restrictive criteria for remote-access surgery.
To compare surgical outcomes, including complication rates, operative time, and hospital stay, between patients meeting ATA criteria and those with larger nodules or thyroiditis.

Main Methods:

Retrospective analysis of patients undergoing robotic transaxillary thyroidectomy from February 2012 to March 2022.

Keywords:

Remote-access thyroidectomy Robot-assisted surgery Robotic transaxillary thyroidectomy Thyroid Thyroidectomy

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Patients were divided into two groups: Group A (thyroid nodule ≤3 cm, lobe <6 cm, no thyroiditis) and Group B (patients not meeting these criteria).

Surgical outcomes, including complication rates, operative time, and hospital stay, were compared between the two groups.

Main Results:

Overall complication rates were comparable between Group A and Group B (p=0.399).
Operative time (p=0.477) and hospital stay (p=0.305) were also similar between the groups.
Bleeding was associated with thyroid nodules >3 cm (p=0.015), with most bleeding occurring at the remote-access site.

Conclusions:

Robotic transaxillary thyroidectomy is a feasible and safe surgical option, even for patients with thyroid nodules larger than 3 cm or those with thyroiditis, when performed by experienced surgeons.
The study challenges the strict limitations set by the 2016 ATA statement, suggesting broader applicability of this technique.
Further research may explore optimizing techniques to minimize bleeding risks in complex cases.