Transoral robotic thyroidectomy using Versius platform: a preclinical feasibility study in cadavers

Remote-access thyroidectomy techniques have been developed to address esthetic concerns related to cervical scarring following conventional thyroidectomy. Transoral robotic thyroidectomy offers a scarless vestibular access combined with the technological advantages of robotic systems. To date, only the Da Vinci platform has been clinically utilized for this procedure. The Versius robotic system is a new robotic platform under development for head and neck surgery. This study aims to evaluate the feasibility and safety of performing transoral thyroidectomy using the Versius robotic system in cadaveric models, as well as to determine the optimal robotic configuration for standardizing the procedure. The study involved four fresh human cadavers (3 female, 1 male). Transoral robotic thyroidectomy was performed using the Versius system. Multiple robotic arm configurations were systematically tested to determine the optimal setup. Total thyroidectomy was successfully completed in all specimens. The optimal configuration utilized a C-shaped arms and a Z-shaped camera, which effectively minimized instrument collisions. The primary technical challenge encountered was instrument collisions, particularly during deep-space dissection. Critical anatomical structures, including the recurrent laryngeal nerves and parathyroid glands, were successfully identified and preserved. In addition, the introduction of a transaxillary fourth arm enhanced surgical exposure. The Versius robotic system demonstrated technical feasibility for transoral thyroidectomy in cadaveric models. Implementation of standardized docking and arm configurations is essential to minimize potential collisions and the incorporation of a transaxillary fourth arm shows promise for improving surgical exposure. Clinical trials are warranted to validate the safety and efficacy of Versius robotic system in live human subjects.