Robotic thyroidectomy: An initial experience with the gasless transaxillary approach

Background: Thyroid surgery has recently emerged as one of the most promising fields for the application of robotic surgery. We report the results of the first year of experience with a gasless transaxillary thyroidectomy. Subjects and Methods: From January 2009 to December 2009, 10 consecutive patients (8 women) underwent robotic thyroidectomy through a gasless transaxillary approach. The median age was 44 years (range, 27-42 years). Eight total and two partial thyroidectomies (one left and one right) were performed using the da Vinci ^® Robotic Surgical System (Intuitive Surgical, Sunnyvale, CA). Preoperative diagnosis included solitary nodules with a median size of 16±11mm (range, 3-44mm) at preoperative imaging. Results: All procedures were successfully completed robotically, except one that was converted because of difficulty in achieving an optimal exposure. The overall mean operative time was 177.4±40 minutes (range, 120-240 minutes) with minimal blood loss (<10mL). Pathological diagnoses included papillary carcinoma (n=6), colloid nodule (n=2), and multinodular goiter (n=2). The mean number of lymph nodes harvested in the cases of malignant disease was 4±5 (range, 3-15). The median postoperative length of stay was 1.05 days (range, 1-1.4 days). Conclusions: Thyroid surgery using a gasless transaxillary approach can be performed safely for selected benign and malignant pathology. This approach offers superior cosmetic results and a short hospital stay over conventional thyroid surgery. For selected patients, this technique offers a promising scarless option for minimally invasive thyroid surgery.