Single-port robotic areolar thyroidectomy: technical feasibility and clinical outcomes of 64 consecutive cases

Single-port robotic areolar (SPRA) thyroidectomy is a recent refinement of the bilateral axillo-breast approach (BABA) that employs the da Vinci single-port system to establish a single-trajectory corridor while preserving a scarless neck. However, clinical data remain limited. The present study evaluated whether SPRA is clinically feasible and technically safe. This retrospective study analyzed 64 consecutive women who underwent SPRA at a single center between March and September 2025. We compared flap dissection extent between SPRA and BABA using a standardized grid-based model and analyzed perioperative outcomes. Console time was analyzed by laterality, body mass index (BMI), and learning phase via cumulative sum (CUSUM) analysis. Less-than-total and total thyroidectomy were performed in 59 (92.2%) and 5 (7.8%) patients, respectively. The mean console time was 69.3 ± 27.4 min and did not differ significantly by laterality or correlate with BMI. CUSUM analysis showed an inflection point at case 15; the late phase (cases 16-60) had significantly shorter console times than the early phase (cases 1-15) (62.9 vs. 82.4 min; median difference, 17.0 min; p = 0.017). Modeled flap dissection area was approximately 28% smaller for SPRA than for BABA. No conversions occurred. Transient vocal cord palsy affected six patients (9.4%) and transient hypoparathyroidism affected one (20% of total thyroidectomies), with no permanent complications. SPRA demonstrated a smaller estimated flap dissection, consistent operative performance, and early stabilization of console time. These findings support SPRA as a safe and feasible integrated platform for remote-access thyroidectomy.