Robotic transaxillary thyroidectomy in children: a retrospective institutional study

Robotic transaxillary thyroidectomy is an established procedure in adults, offering a scar-free-in-the-neck result. Application of this technique in the pediatric population, where thyroid disease can be more aggressive and cosmetic outcomes carry lifelong developmental and psychosocial significance, remains limited and underreported. This study reports the feasibility, safety, and perioperative outcomes of robotic transaxillary thyroidectomy in a pediatric cohort.

Single-institution retrospective cohort study of all pediatric patients (age ≤18 years) who underwent robotic transaxillary thyroidectomy at our institution between January 2012 and December 2022. Descriptive statistics were used; no formal comparative analysis was performed owing to the absence of a contemporaneous control group.

Fifteen patients were included (mean age 14.3±2.5 years; 13 adolescents, 2 children ≤12 years; 80% female). Indications: indeterminate cytology (Bethesda III/IV, n=6, 40%), biopsy-confirmed papillary thyroid carcinoma (PTC, n=7, 46.7%), and benign goiter (n=2, 13.3%). Eight patients (53.3%) underwent lobectomy; seven (46.7%) total thyroidectomy; central neck dissection (CND) in five (33.3%). Mean operative time was 210±45 minutes (range, 140-300 minutes), decreasing to 180±30 minutes in the last five cases-substantially longer than published open pediatric benchmarks (65-134 minutes). No conversion to open surgery occurred. All 15 patients underwent routine postoperative flexible nasolaryngoscopy (FNL); no vocal cord motion impairment was identified. Two patients (13.3%) experienced transient hypocalcaemia; one (6.7%) an axillary seroma; both resolved without sequelae. R0 resection was achieved in all malignant cases. No PTC recurrences were observed at median 2.8-year follow-up (range, 0.5-5.0 years). No validated QoL or cosmetic assessment was performed in this pediatric cohort.

In this small single-institution series, robotic transaxillary thyroidectomy was technically feasible and safe in carefully selected pediatric patients, with low morbidity and short hospital stays. These findings are hypothesis-generating only and do not establish superiority over conventional open thyroidectomy. The substantially longer operative time and absence of validated patient-reported outcome data are key limitations. Prospective multi-centre studies with validated QoL instruments and a contemporaneous control group are urgently needed.