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Updated: Jul 1, 2025
Gasless Endoscopic Thyroidectomy via the Trans-Axillary Approach
Published on: September 15, 2023
Gasless robot-assisted transaxillary hemithyroidectomy (RATH): learning curve and complications
Pengfei Xu1, Qi Fang1, Junhao Mai2
1Department of Head and Neck Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, Guangdong, 510060, P. R. China.
Gasless robot-assisted transaxillary hemithyroidectomy (RATH) offers a viable alternative to conventional surgery, demonstrating a manageable learning curve for surgeons. This minimally invasive approach resulted in fewer patients experiencing thyroid area traction post-operation.
Area of Science:
- Minimally Invasive Surgery
- Surgical Oncology
- Robotic Surgery
Background:
- Gasless robot-assisted transaxillary hemithyroidectomy (RATH) is an emerging surgical option for thyroid procedures.
- A significant concern with RATH is its steep learning curve for surgeons, particularly those new to endoscopic techniques.
Purpose of the Study:
- To evaluate the learning curve associated with RATH for surgeons without prior endoscopic surgery experience.
- To assess the early surgical outcomes of gasless RATH.
- To compare the outcomes of RATH with conventional hemithyroidectomy (CH).
Main Methods:
- A retrospective study comparing 105 patients who underwent gasless RATH with 104 patients who underwent CH.
- Cumulative sum (CUSUM) analysis was used to evaluate the learning curve, focusing on operative time, drainage amount, and blood loss.
- Perioperative complications and postoperative sensory changes were compared between the two groups.
Main Results:
- CUSUM analysis indicated the learning curve peak for operative time occurred around the 31st case of gasless RATH.
- No significant differences in perioperative complications were observed between the RATH and CH groups.
- Fewer patients in the RATH group reported a sense of thyroid area traction post-surgery (10.5%) compared to the CH group (30.8%).
Conclusions:
- Gasless RATH presents a feasible alternative to conventional open hemithyroidectomy.
- The technique is characterized by an accessible learning curve and offers advantages such as reduced postoperative sensation of thyroid area traction.
- RATH is highlighted as an easy remote-access technique with favorable early outcomes.
