Transaxillary Robotic Thyroidectomy: A Novel Technique and Update.

Area of Science:

• Robotic Surgery
• Endocrine Surgery
• Surgical Innovation

Background:

• Gasless Transaxillary Robotic Thyroidectomy (G-TART) requires advanced techniques for improved surgical outcomes.
• Enhancing precision and safety in the confined transaxillary (TA) surgical field is crucial for thyroidectomy.

Purpose of the Study:

• To introduce a novel technique integrating dynamic endoscope repositioning (swing technique) with specialized intraoperative neuromonitoring (IONM) for robotic thyroid surgery.
• To evaluate the safety and efficacy of this combined approach in Gasless Transaxillary Robotic Thyroidectomy (G-TART).

Main Methods:

• The Da Vinci Xi system was used for the procedure.
• A novel 'swing technique' dynamically repositioned the endoscope for enhanced visualization during recurrent laryngeal nerve (RLN) dissection.
• A specialized Modena Robotic Probe was used with intermittent IONM for precise RLN mapping and verification.

Main Results:

• The swing technique improved visualization in the narrow TA surgical field, especially during contralateral dissection.
• The Modena Robotic Probe facilitated accurate RLN tracking and verification.
• The integrated approach potentially minimizes risks of nerve injury and enables safer navigation.

Conclusions:

• This novel technique combining the swing technique and Modena Robotic Probe enhances safety and accuracy in G-TART.
• Procedure-specific robotic approaches are vital for advancing thyroid surgery.
• Further adoption of advanced imaging and specialized instrumentation can improve surgical results.