Experience Based Procedure Guide for Robotic Bilateral Axillo-breast Approach (BABA) Thyroidectomy Using the SSI...

Open thyroidectomy remains the standard treatment for most thyroid disorders; however, concerns regarding permanent cervical scarring have led to increasing adoption of remote-access techniques. The bilateral axillo-breast approach (BABA) provides symmetric access and familiar anatomy while avoiding a neck incision. Robotic assistance further enhances precision and ergonomics. The SSI MANTRA robotic system is a newer, indigenously developed platform, but procedural standardization for robotic BABA thyroidectomy using this system is limited. To present an experience-based procedural roadmap for robotic BABA thyroidectomy using the SSI MANTRA robotic system and to evaluate its feasibility, safety, and early outcomes. This prospective case series included 32 patients who underwent robotic BABA thyroidectomy using the SSI MANTRA system. A standardized procedural guide encompassing preoperative optimization, operating room setup, patient positioning, port placement, docking strategy, instrumentation, and stepwise surgical technique was developed. Demographic characteristics, intraoperative variables, and early postoperative outcomes were analyzed. The mean age was 29 years, with a female predominance (87.5%). The mean total operative time was 189.4 ± 41.9 min, with a mean docking time of 31.2 ± 11.3 min and a mean console time of 121.3 ± 38.4 min. Mean blood loss was 24 ml. No intraoperative recurrent laryngeal nerve or tracheal injuries occurred. Transient vocal cord palsy was observed in 2 patients (6.25%) and transient hypoparathyroidism in 3 patients (9.37%), with no permanent complications. Other postoperative events were infrequent and managed conservatively. Robotic BABA thyroidectomy using the SSI MANTRA robotic system is a safe and feasible remote-access technique with acceptable operative efficiency and low early morbidity. The standardized procedural roadmap may enhance reproducibility and facilitate wider adoption. Larger studies with long-term follow-up are warranted.