Novel robot-assisted thyroidectomy by a transaxillary gas-insufflation approach (TAGA): a preliminary report

Abstract

Background: Robot-assisted transaxillary approaches to thyroidectomy have been well described. They have an advantage over the breast approach in that a circumareolar incision is avoided. However, they require a single long axillary incision to accommodate all 3 robotic arms and provide adequate visualization of the area around the thyroid. The purpose of this study was to test the feasibility of the robot-assisted transaxillary gas-insufflation approach (TAGA) and to attempt reducing the size of the scar.Methods: We evaluated 47 patients who underwent robot-assisted thyroid lobectomy via TAGA from July 2015 to Aug 2017. The following variables were studied: patients' demographics, operative time according to each operation step, volume of drainage, duration of hospitalization, and perioperative complications. Results:The mean age of all patients was 42.4±9.1 years. The mean total volume of drainage was 195.4±70.9 mL, and the duration of postoperative stay was 3.0±1.1 days. Two cases (4.3%) of transient vocal cord palsy and 2 cases (4.3%) of seroma were identified postoperatively. There was no post-operative cosmetic problem at the skin incisions made in the axilla.Conclusions: Robot-assisted thyroid lobectomy via TAGA is technically feasible while achieving good cosmetic results. TAGA can be an alternative robot-assisted method for thyroidectomy.

Comparative Study of Gasless Transaxillary, Bilateral Axillo-Breast, Unilateral Axillo-Breast With Carbon Dioxide Insufflation, Retroauricular, and Transoral Vestibular Endoscopic Thyroidectomy Approaches at a Single Institution: A Retrospective Analysis and Lessons Learned

“…The cosmetic results are good because UABA only leaves two small scars in the axilla and one small scar in the periareolar area. UABA and a modification of UABA using a robot system, called the transaxillary gas-insufflation approach, has been performed at some thyroid centers, with good overall patient satisfaction [ 22 , 23 ].…”

Endoscopic total thyroidectomy using a unilateral transaxillary approach: A case report

“…Although several studies have reported the use of robot-assisted total thyroidectomy through a unilateral axillary approach, 7–9 to our knowledge, no studies have reported this procedure using endoscopy. Indeed, because of the perceived difficulty in accessing the contralateral anatomy of the thyroid gland, endoscopic transaxillary thyroidectomy is considered only suitable for unilateral lobectomy.…”

“…6 Initially, transaxillary thyroidectomy was performed using a unilateral axillobreast approach and robot assisted manipulation with gas-insufflation using a 3-port system. [7][8][9] A gasless method was established in 2001 and it has now become the most widely used endoscopic transaxillary thyroidectomy procedure. 10 Over the years, the procedure has improved and studies show it is comparable to open thyroidectomy in terms of early surgical outcomes and complications.…”