Related Experiment Video
Updated: Aug 6, 2026
Subcostal Specimen Removal in Completely Portal Robotic Lobectomy
Published on: April 19, 2024
Not all patients need a robot: comparative perioperative outcomes of robotic BABA versus endoscopic CABBA thyroid
Ting Yan1, Zheng Ding1, Rui Xiao1
1Department of Thyroid, Parathyroid, Breast and Hernia Surgery, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China.
Abstract:
Endoscopic thyroid surgery is increasingly used for papillary thyroid carcinoma (PTC), but whether robotic bilateral axillo-breast approach (BABA) offers meaningful perioperative advantages over endoscopic contralateral axillo-bilateral-breast approach (CABBA) for unilateral lobectomy with ipsilateral central lymph node dissection (CLND) is unclear. This retrospective cohort study at Shanghai Sixth People's Hospital (2021-2025) aimed to compare outcomes between robotic BABA and endoscopic CABBA after lobectomy plus ipsilateral CLND for PTC, stratified by body mass index (BMI: <24 vs. ≥ 24 kg/m²). Propensity score matching was applied within each BMI stratum. Among 116 non-overweight patients (BMI < 24; median age 33.0 years; 87.1% female), operative time (150.0 vs. 137.5 min; median diff 12.0 min; 95% CI 0 to 24; P = 0.087) and central lymph node yield (7.0 vs. 6.0; median diff - 1.0; 95% CI - 3 to 1; P = 0.435) were comparable between robotic BABA and endoscopic CABBA. Robotic BABA was associated with significantly higher cost (median ¥51,394 vs. ¥22,043; median diff ¥29,351; 95% CI ¥26,100-¥32,600; P < 0.001) and longer incision length (median 4.00 vs. 2.80 cm; median diff - 1.20 cm; 95% CI - 1.20 to - 1.20; P < 0.001). Among 32 overweight/obese patients (BMI ≥ 24; median age 32.0 vs. 31.0 years; 56.3% female), robotic BABA achieved higher central lymph node yield (6.5 vs. 2.5; median diff - 4.0; 95% CI - 8 to - 1; P = 0.003), with comparable operative time (142.5 vs. 140.0 min; median diff - 5.0; 95% CI - 20 to 10; P = 0.595) and hospital stay (3.0 vs. 3.0 days; median diff 0; 95% CI 0 to 1; P = 0.147). Endoscopic CABBA retained cost and cosmetic advantages in both strata (both P < 0.001). In non‑overweight patients undergoing lobectomy with ipsilateral CLND for PTC, robotic BABA provides no perioperative advantage over endoscopic CABBA and is less cost‑effective. In overweight/obese patients, robotic BABA improves central lymph node clearance. These findings support BMI‑based patient selection for robotic thyroidectomy.
