Robotic thyroidectomy by a gasless unilateral axillo-breast or axillary approach: our early experiences.

BACKGROUND: Various endoscopic thyroidectomy procedures have been designed to minimize visible scarring. However, endoscopic thyroidectomies have some limitations in obtaining adequate surgical views and in the precise manipulations of the endoscopic instrument. Recently, robotic technology has been applied to thyroid surgery. The aim of this study was to determine the technical feasibility, intraoperative safety, and efficacy of robotic thyroidectomy.

METHODS: We analyzed 41 patients with thyroid nodules who underwent robot-assisted endoscopic thyroidectomy from October 2008 to August 2009 using a gasless unilateral axillo-breast or axillary approach with a da Vinci S Surgical System robot at Hanyang University Hospital, Seoul, Korea. We also compared the early surgical outcomes of robotic thyroidectomies with those of 167 patients who underwent conventional open thyroidectomies during the same period.

RESULTS: In the robotic group, there were more female patients (P = 0.001) and the mean age was younger than that of the open thyroidectomy group (P < 0.001). The robotic thyroidectomy surgical procedure was completed successfully in all patients. Unilateral lobectomy was performed in 29 patients and total thyroidectomy was performed in 10 patients. The rate of central compartment neck dissection (CCND) for thyroid cancer was not different between the two groups (P = 0.127). The operative time was longer and the amount of drainage was higher in the robotic group than the open group (P < 0.001 and P = 0.002, respectively). The complication rate was not different between the two groups. The postoperative pain score of the neck and anterior chest was not different between the two groups except the anterior chest pain score at postoperative week 1. The cosmetic satisfaction was greater in the robotic group (P < 0.001).

CONCLUSION: Robot-assisted endoscopic thyroidectomy by a gasless unilateral axillo-breast or axillary approach using a da Vinci S Surgical System robot is a safe, feasible, and cosmetically excellent procedure. It can be a promising alternative to endoscopic thyroidectomy or conventional open thyroidectomy.