A new technique for robotic thyroidectomy: “the daVinci gasless single-incision axillary approach”

Abstract

Robotic thyroidectomy has been recently introduced as a new modality of treatment for selected benign and malignant thyroid lesions. The standard technique, popularized by a leading Korean group, combines an axillary and a thoracic approach to accomplish thyroid resection without neck incision. We recently introduced a modified technique that has enabled us to complete robotic thyroidectomy through a single axillary incision. We herein report our initial successful experience in 35 cases with the modified technique.

Conversion rates in robotic thyroid surgery: A systematic review and meta‐analysis

“…Table 2 reports the characteristics and demographics of the included studies. 11 articles were prospective cohort studies, [15][16][17][18][19][20][21][22][23][24][25] one was a prospective case-control study 26 and one was a randomized controlled trial, RCT. 27 Four studies were performed in Europe (Great Britain, Greece, Italy, and Romania), four in the United States of America, and five in Asia (China, n = 2, and South Korea, n = 3).…”

“…Each study employed a specific RATS approach and no intra‐study comparison for RATS approaches was available. Two studies 15 , 25 reported a total of 4 conversions into open procedures, all occurring during TGA total thyroidectomies. One conversion was due to excessive bleeding in a female patient, another one was due to unexpected high glandular volume (multinodular goitre) and two were due to previously undetected significant tumour extension (specifically, a papillary cancer invading the cricothyroid area and a follicular carcinoma with cranial extension).…”

“…31,32 The 1% conversion rate stemmed from four different events during TGA total thyroidectomies reported in two studies from different groups. 15,25 These data were recovered from a set of 398 robot-assisted procedures in 13 average-to-good methodological quality small-scale prospective studies. Despite the good evidence level and methodological consistency, the relatively small scale of Rodriguez et al, 2011 25 Unspecified benign histology (n = 12) Follicular carcinoma (n = 19), hurtle cell carcinoma (n = 1), papillary carcinoma (n = 3) studies determined a moderate degree of publication bias, which should be hopefully covered by future larger-scale studies.…”

“…15,25 These data were recovered from a set of 398 robot-assisted procedures in 13 average-to-good methodological quality small-scale prospective studies. Despite the good evidence level and methodological consistency, the relatively small scale of Rodriguez et al, 2011 25 Unspecified benign histology (n = 12) Follicular carcinoma (n = 19), hurtle cell carcinoma (n = 1), papillary carcinoma (n = 3) studies determined a moderate degree of publication bias, which should be hopefully covered by future larger-scale studies. The procedures taken into account cover most types of thyroid surgery types (ST, HT, and TT, with a clear predominance of the last, accounting for 62% of procedures), with or without ND, performed with three distinct access types (BABA, RFA, and TGA, the last accounting alone for 53% of procedures).…”

Robot Assisted Trans Axillary Thyroidectomy: A Subcontinent Experience

“…Trans axillary thyroidectomy poses the risk of brachial plexus injury due to arm position, thus in our case series we compared two arm positions. For the first four cases we used overhead arm position and for the last three cases we fixed the arm at 90°as used by Rodriguez et al [12]. In their case series of 338 patients Kang et al reported one case of brachial plexus injury and Landry et al [13] in their case series of 14 patients reported 2 patients with brachial plexus injury.…”