Perioperative and oncologic outcomes of 1,000 consecutive single-port transaxillary robotic thyroidectomy (SP-TART)

Evidence on single-port transaxillary robotic thyroidectomy (SP-TART) remains limited. We evaluated perioperative outcomes, early oncologic results, and complication-specific risk factors in a large consecutive SP-TART cohort.

We retrospectively reviewed 1,000 consecutive patients who underwent da Vinci SP-TART at a single institution between 2021 and 2025. Perioperative outcomes, postoperative complications, and clinicopathologic data were collected from medical records and final pathology reports. Hypoparathyroidism was classified as transient (≤ 12 months) or permanent (> 12 months), and recurrent laryngeal nerve (RLN) injury was confirmed by postoperative laryngoscopy. Logistic regression analyses were performed to identify factors associated with RLN injury and hypoparathyroidism.

Mean age was 40.9 ± 11.6 years, and 87.2% of patients were female. Less-than-total thyroidectomy was performed in 83.0%, total thyroidectomy in 8.9%, completion thyroidectomy in 0.4%, and modified radical neck dissection in 7.7%. Mean operative time was 79.1 ± 42.0 min. Final pathology was malignant in 85.1%, benign in 11.6%, and noninvasive follicular thyroid neoplasm with papillary-like nuclear features in 3.3%. Among malignant cases, papillary thyroid carcinoma accounted for 98.2%, and mean tumor size was 1.1 ± 0.9 cm. Major postoperative complications included transient and permanent hypoparathyroidism in 7.4 and 0.4%, respectively, and transient and permanent RLN injury in 4.1 and 0.2%, respectively. During a mean follow-up of 22.7 ± 13.3 months, recurrence occurred in 0.8%, with no disease-specific mortality. In the less-than-total cohort, larger tumor size and gross extrathyroidal extension were independently associated with RLN injury. In the total thyroidectomy/completion thyroidectomy/modified radical neck dissection cohort, no independent risk factor for hypoparathyroidism was identified.

SP-TART demonstrated acceptable perioperative outcomes and low early recurrence during short-term follow-up in a large consecutive cohort predominantly composed of low-risk thyroid cancer patients. Surgical extent was closely associated with hypoparathyroidism, whereas RLN injury was more strongly related to tumor burden and local invasiveness.