Robotic Completion Thyroidectomy via the Bilateral Axillo-Breast Approach

Abstract

Background: Bilateral axillo-breast approach (BABA) robotic thyroidectomy has been successfully performed for thyroid cancer patients with excellent cosmetic results. Completion thyroidectomy is sometimes necessary after thyroid lobectomy, and whether it has a higher complication rate than the primary operation due to the presence of adhesions remains controversial. The aim of this study was to evaluate surgical outcomes, including operation time and postoperative complications, in patients who underwent BABA robotic completion thyroidectomy. Methods: From Jan 2012 to Aug 2020, 33 consecutive patients underwent BABA robotic completion thyroidectomy for a thyroid malignancy after BABA robotic thyroid lobectomy. The procedures were divided into five steps: (1) robot setting and surgical draping, (2) flap dissection, (3) robot docking, (4) thyroidectomy, and (5) closure. Clinicopathological characteristics, operation time, and postoperative complications were reviewed. Results: The total operation time was shorter for completion thyroidectomy than for the initial operation (164.8 ± 31.7 min vs. 179.8 ± 27.1 min, p = 0.043). Among the robotic thyroidectomy steps, the duration of the thyroidectomy step was shorter than that of the initial operation (69.6 ± 20.9 min vs. 83.0 ± 19.5 min, p = 0.009. One patient (1/33, 3.0%) needed hematoma evacuation under the flap area immediately after surgery. Three patients (3/33, 9.1%) showed transient hypoparathyroidism, and one patient (1/33, 3.0%) had permanent hypoparathyroidism. Two patients (2/33, 6.1%) showed transient vocal cord palsy and recovered within 3 months following the completion thyroidectomy. There were no cases of open conversion, tracheal injury, flap injury or wound infection. Conclusions: BABA robotic completion thyroidectomy could be performed safely without completion-related complication.

Outcomes of Minimally Invasive Thyroid Surgery – A Systematic Review and Meta-Analysis

“…Of the studies included in this article, completion thyroidectomy was described by eight studies, using all mentioned techniques except the RA-ET and RA-RT (31,34,41,43,46,57,65,89). Moreover, several other studies described the safety and feasibility of minimally invasive techniques for the completion thyroidectomy, showing the vast range of application of these techniques (65,(120)(121)(122). It is advised to either perform re-operation within two weeks after initial surgery or after two to three months to minimize complications due to adhesions (57,65,120).…”

Learning curve for robotic thyroidectomy using BABA: CUSUM analysis of a single surgeon’s experience

“…BABA RT is one of the most popular remote-access approaches for thyroid surgery ( 22 ). Several studies have revealed that BABA robotic completion thyroidectomy could be performed safely without completion-related complication ( 22 , 23 ). The experiences of utilizing BABA RT in lateral neck dissection have been shared in a few studies ( 10 ).…”

Working Space Creation in Transoral Thyroidectomy: Pearls and Pitfalls

“…The time interval between the two surgeries exceeded 2 weeks in three patients, and there was no open conversion. Similar experience from the bilateral axillo-breast approach also revealed a 100% success rate in 33 consecutive patients who underwent completion thyroidectomy through the same route [ 66 ]. The mean interval between the two surgeries was 5.5 months in their study.…”