Operative performance evolution in robotic transaxillary thyroidectomy: an 884-case institutional experience

Area of Science:

• Surgical Oncology
• Endocrine Surgery
• Robotic Surgery

Background:

• Remote-access thyroidectomy via the robotic transaxillary approach (RTAT) offers scarless surgery and a magnified operative field.
• The evolution of high-volume RTAT programs, including case acquisition and expansion of indications, is not well-characterized in Western literature.

Purpose of the Study:

• To analyze the institutional lifespan evolution of a high-volume robotic transaxillary thyroidectomy (RTAT) program.
• To assess changes in operative time, complication rates, and surgical indications over program phases.

Main Methods:

• Retrospective analysis of 884 consecutive RTAT procedures at a single tertiary referral center.
• Cases stratified into early (1-295), middle (296-589), and late (590-884) chronological phases.
• Comparison of operative extent, operative time, conversion rate, and complications across eras; multivariable regression for operative time predictors.

Main Results:

• Mean operative time decreased from 159.7 min (early) to 133.4 min (middle) (p<0.001).
• Total thyroidectomy rates increased (42.0% to 50.0%), as did malignancy proportion (8.5% to 14.9%).
• Access-specific morbidity, including transient RLN weakness and brachial plexopathy, significantly decreased over time; no permanent RLN injury or hypoparathyroidism occurred.

Conclusions:

• Operative time and access-specific morbidity declined significantly with program maturation in RTAT.
• The RTAT program safely broadened indications to include more bilateral resections and oncological disease.
• Findings support staged RTAT program development at experienced centers, highlighting safety and efficiency gains.