Robot Assisted Trans Axillary Thyroidectomy: A Subcontinent Experience

Abstract

To evaluate the outcome and initial hurdles of transaxillary robotic thyroidectomy in the Indian subcontinent. A total of seven (n = 7) patients were operated from August 2016 to February 2017. Ultrasonography was used as a tool to decide the size of thyroid lobe and fine needle aspiration cytology for the type of lesion. All patients underwent ipsilateral brachial plexus nerve conduction studies preoperatively. Two arm positions were evaluated. The robot was docked at the contralateral side of the surgical field. Before discharge from hospital, all patients were given a questionnaire evaluate outcome. Set 1 was answered on the day of discharge and Set 2 at one-month follow up. The most common pathology in our case series was colloid goiter (n = 4) followed by follicular lesion (n = 3). The mean console time was 167 min, with initial two cases taking more than 200 min. The maximum and minimum length of the axillary tunnel was 16 and 27 cm respectively. There was no difference with regard to complication rate with either arm position. None of the patients developed brachial plexus injury and was confirmed by normal nerve conduction study done on postoperative day three. In our experience with transaxillary robotic thyroidectomy, the problems we faced in our population were unique considering the varied physical parameters. Use of malleable retractors comes handy in these situation and we recommend the use of these over the rigid ones. Though both the arm positions had similar outcomes, the one with sideways position was more favorable.

Microscopic Thyroidectomy: A Prudent Option

“…For small tumours robotic and endoscopies methods work fine and they provide adequate magnification for nerve identification. Robotic thyroidectomy provide 10 9 magnification and it is easy to identify nerve using robotic technique [5]. RLN injury rate vary and from world centres of excellence, the reported rate is around 0.25-0.7% [6].…”

Robot Assisted Trans Axillary Thyroidectomy: A Subcontinent Experience

“…We read with interest ''Robot Assisted Trans Axillary Thyroidectomy: A Subcontinent experience'' by Gupta et al [1]. We congratulate the authors on their ''three arm single incision'' technique and their results they achieved, even though the numbers are small.…”