Postsurgical complications after robot-assisted transaxillary thyroidectomy: critical analysis of a large cohort of European patients

Abstract

In the last decade, robot-assisted trans-axillary thyroidectomy has spread rapidly and has been proven to be a safe and effective procedure. However, several case series have reported new complications that have led to criticism regarding this approach. This study analyzed the incidence of complications in a large cohort of European patients. We enrolled all patients who underwent robot-assisted trans-axillary thyroidectomy from 2012 to 2020 at the University Hospital of Pisa Department of Endocrine Surgery. We analyzed complications and divided them into 2 groups. Group A included conventional complications, such as transient or permanent recurrent laryngeal nerve palsy, transient or permanent hypocalcemia, hemorrhage, and tracheal injury. Group B included unconventional complications, such as brachial plexus palsy, track seeding, seroma, great vessels injury, and skin flap perforation. There were 31 postsurgical complications (5.7%). Group A included 25 complications (4.6%): transient and permanent recurrent laryngeal nerve palsy occurred in 7 patients (1.3%) and in 1 (0.2%), respectively; transient and permanent hypocalcemia occurred in 9 patients (1.7%) and in 1 (0.2%), respectively. Postoperative bleeding occurred in 6 patients (1.1%) and tracheal injury in 1 (0.2%). Group B included 6 complications (1.1%): 1 patient with brachial plexus injury (0.2%), 1 with track seeding (0.2%), and 4 with seroma (0.7%). Robotic trans-axillary thyroidectomy is a safe approach with a risk of postoperative complications comparable to the conventional technique. Almost all complications after a novel introduction are anecdotal. With an accurate patient selection, high-volume institutions with experienced surgeons can perform this technique safely.

Robotic transaxillary thyroidectomy: time to expand indications?

“…The Authors reported that it has never account for more than 1% of thyroid surgeries per year and that the majority of procedures were performed by low-volume institutions, although these were associated to a significant higher rate of surgical complications compared to high-volume ones (p = 0.02) [5]. Moreover, the introduction on novel complications [14] and prohibitive costs hinder the diffusion of RATT in the Western World and several Authors heavily criticized this new approach [15][16][17].…”

“…Although anthropometrics' and thyroid's features of European patients are similar to those of Americans, in Europe some high-volume institutions perform RATT routinary reporting case series of hundreds of patients [14,21,22].…”

“…In 2016, when the American Thyroid Association published its statement regarding remote-access thyroidectomy [6], we had already performed more than 200 cases [9], most of them beyond American recommendations. Although we already documented the overall feasibility and safety of RATT reporting excellent complications rate [14], we felt the necessity to further investigate whether our performances in the daily practice with patients beyond ATA recommendations are actually associated to worse surgical outcomes.…”

Does the continuation of low-dose acetylsalicylic acid during the perioperative period of thyroidectomy increase the risk of cervical haematoma? A 1-year experience of two Italian centers

“…Thyroidectomy is the most frequently performed surgical procedure in endocrine surgery, for the treatment of both benign diseases and malignancy (19)(20)(21)(22).…”

Management of the brachial plexus in head and neck cancer

“…Neuropraxia of the brachial plexus is thought to result from extreme arm extension and surgical flap retraction [25]. The incidence of brachial plexus injury is reported at 0.2-2.2% [24,26,27]. Fortunately, brachial plexus injury caused by RATS is generally transient as it is due to neuropraxia and improves over time (in contrast to nerve transection) [28,29].…”