Initial Experience With Robotic Modified Radical Neck Dissection Using the da Vinci Xi System Through the Bilateral Axillo-Breast Approach

Abstract

Objectives: The bilateral axillo-breast approach (BABA) to robotic thyroidectomy has been extended to modified radical neck dissection (MRND). This study assessed outcomes in patients who underwent robotic MRND through BABA using the da Vinci Xi system. Methods: The medical records of 40 patients who underwent total thyroidectomy, bilateral central neck dissection and MRND from September 2018 to March 2020 were reviewed retrospectively, including 12 who underwent robotic surgery and 28 who underwent open surgery. All operations were performed by a single endocrine surgeon. Results: Operation time was significantly longer in the robotic than in the open group (277.08

Single Surgeon Experience of 500 Cases with the Robotic Bilateral Axillary Breast Approach (BABA) for Thyroid Surgery using the da-Vinci Xi System

“…[22] Thus, we can reduce the breast and axillary scar size and expand our surgery to MRND cases, as we reported elsewhere. [9,18] Although the patients were older, the proportion of males was higher, the tumor size was larger, and the BMI was higher in our analysis, the surgical indication for BABA RT in our hospital was not different from that for OT. Contraindications of BABA RT in our hospital are direct invasion of adjacent organs by the main tumor or metastatic nodes (trachea, vertebra, carotid artery, jugular vein, etc.…”

“…[10,20] BABA RT has been performed for more than 10 years, and its surgical indications expanded widely to include large thyroid cancers, minor extrathyroidal extension, neck node dissection including central and lateral neck nodes (MRND), and combined thyroiditis or Graves' disease. [9] Surgical and oncologic safety has also been shown in many previous studies. [4,12,17,20,21] Beginning on December 24, 2018, BABA RT using the da-Vinci Xi system was started in our hospital.…”

“…However, with the advancement of robotic surgical devices (the da-Vinci surgical system), remote-access thyroid surgical methods are shifting to robotic thyroidectomy because it can provide a better visual field through a 15-fold magnified full 3D vision and a wide range of motion by means of the endowrist function that implements the same movement as a surgeon's hand. [9][10][11] The robotic BABA was initially started in 2008 at the Seoul National University Hospital, and the hospital recently reported more than 1000 cases of robotic BABA. [12][13][14] Regarding the robotic BABA, many studies have reported that robotic thyroidectomy is a good surgical method in terms of surgical stability and favorable surgical completeness.…”

Single Surgeon Experience with 500 Cases of the Robotic Bilateral Axillary Breast Approach (BABA) for Thyroid Surgery Using the Da-Vinci Xi System

“…Camera access is possible with 4 ports, so we can get various viewpoints and provides new endowrist instruments such as Vessel Sealer Extend [23]. Thus, we can reduce the breast and axillary scar size and expand our surgery to MRND cases, as we reported elsewhere [9,19].…”

Robotic Modified Radical Neck Dissection Through the Bilateral Axillary Breast Approach

“…The BABA robotic approach leaves a smaller scar than any other method and provides a symmetric view as in the conventional approach. According to a recent study, the mean numbers of retrieved LNs were not significantly different between open and robotic groups, especially at level 6 (10.61±5.53 in the open group vs. 10.33±5.25 in the robotic group, P =0.883) and level 4 (6.39±4.99 in the open group vs. 7.75±5.38 in the robotic group, P =0.464) [ 8 ]. The authors of that study [ 8 ] subdivided the operating time between the robotic group and the open group and found no significant difference in console time between the two groups (191.43±60.43 minutes in the open group vs. 200.33±26.86 minutes in the robotic group).…”