Robotic transaxillary thyroidectomy for multinodular goiter: a volume-stratified analysis of feasibility and safety

Robotic transaxillary thyroidectomy (RTAT) is an established remote-access technique, yet the impact of goiter size on surgical feasibility and safety remains a subject of debate. This study evaluates the outcomes of RTAT for multinodular goiter (MNG), specifically analyzing the influence of thyroid volume on operative metrics and complication rates. A retrospective analysis was conducted on 44 patients who underwent RTAT for MNG. Patients were stratified into three groups based on thyroid volume: Small (<30 mL), Medium (30-60 mL), and Large (≥60 mL). The da Vinci Xi Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) was utilized following a standard institutional protocol. Hypocalcemia data were available for 43 patients: 22 of 23 in the Small group, 15 of 15 in the Medium group, and 6 of 6 in the Large group. Statistical analyses were performed to compare group outcomes. The cohort (N = 44) was stratified into Small (n = 23), Medium (n = 15), and Large (n = 6) groups (Figure 1). The overall robotic completion rate was 97.7% (43/44), with one conversion to open surgery (2.3%). Operative time significantly increased with larger goiter volumes (Small: 142.1 ± 28.9 min, Medium: 165.3 ± 38.1 min, Large: 180.5 ± 30.7 min; P = 0.015). Post-hoc analysis revealed a significant difference between the Small and Large groups (P = 0.013). The length of hospital stay remained stable across all groups (P > 0.05). Overall transient complication rates included recurrent laryngeal nerve (RLN) palsy in 2.3% (1/44) and hypocalcemia in 20.9% (9/43). No statistically significant differences in complication rates were observed across groups (P > 0.05). RTAT appears technically feasible in carefully selected patients with multinodular goiter across a range of thyroid volumes. Larger thyroid volume was associated with longer operative time. Although postoperative complication rates did not differ significantly, the study was underpowered for these outcomes, particularly in the ≥60-mL subgroup. These findings should therefore be interpreted cautiously and require validation in larger multicenter studies.