Robotic transaxillary total thyroidectomy through a single axillary incision

Aliyev, Shamil; Taşkın, Halit Eren; Ağcaoğlu, Orhan; Aksoy, Erol; Milas, Mira; Siperstein, Allan; Berber, Eren

doi:10.1016/j.surg.2012.10.013

Cited by 40 publications

(75 citation statements)

References 8 publications

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“…In this study, the patient characteristics reflected the nature of In another report from the United States, a single-incision three-arm technique for transaxillary total thyroidectomy was described in 16 patients (17). With a similar patient demographic and clinical profile (Table 1), there were no nerve injuries while asymptomatic hypocalcemia was observed in two patients and hematoma in one.…”

Section: Discussionmentioning

confidence: 73%

American Thyroid Association Statement on Remote-Access Thyroid Surgery

Berber

Bernet

Fahey

et al. 2016

Thyroid

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Background: Remote-access techniques have been described over the recent years as a method of removing the thyroid gland without an incision in the neck. However, there is confusion related to the number of techniques available and the ideal patient selection criteria for a given technique. The aims of this review were to develop a simple classification of these approaches, describe the optimal patient selection criteria, evaluate the outcomes objectively, and define the barriers to adoption. Methods: A review of the literature was performed to identify the described techniques. A simple classification was developed. Technical details, outcomes, and the learning curve were described. Expert opinion consensus was formulated regarding recommendations for patient selection and performance of remote-access thyroid surgery. Results: Remote-access thyroid procedures can be categorized into endoscopic or robotic breast, bilateral axillobreast, axillary, and facelift approaches. The experience in the United States involves the latter two techniques. The limited data in the literature suggest long operative times, a steep learning curve, and higher costs with remote-access thyroid surgery compared with conventional thyroidectomy. Nevertheless, a consensus was reached that, in appropriate hands, it can be a viable option for patients with unilateral small nodules who wish to avoid a neck incision. Conclusions: Remote-access thyroidectomy has a role in a small group of patients who fit strict selection criteria. These approaches require an additional level of expertise, and therefore should be done by surgeons performing a high volume of thyroid and robotic surgery.

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Section: Discussionmentioning

confidence: 73%

American Thyroid Association Statement on Remote-Access Thyroid Surgery

Berber

Bernet

Fahey

et al. 2016

Thyroid

Self Cite

208

179

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“…Finally, we had concerns about the adequacy of exposure. Our groups have had long-term experience in another remote-access technique, transaxillary thyroidectomy (24)(25)(26). Despite the direct access into the neck, in our opinion, dissection of the lateral borders of the thyroid lobes was more difficult in the transoral compared to the axillary approach.…”

Section: Discussionmentioning

confidence: 86%

Robotic and endoscopic transoral thyroidectomy: feasibility and description of the technique in the cadaveric model

et al. 2017

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Background: Numerous new approaches have been described over the years to improve the cosmetic outcomes of thyroid surgery. Transoral approach is a new technique that aims to achieve superior cosmetic outcomes by concealing the incision in the oral cavity.Methods: Transoral thyroidectomy through vestibular approach was performed in two institutions on cadaveric models. Procedure was performed endoscopically in one institution, while the robotic technique was utilized at the other.Results: Transoral thyroidectomy was successfully performed at both institutions with robotic and endoscopic techniques. All vital structures were identified and preserved.Conclusions: Transoral thyroidectomy has been performed in animal and cadaveric models, as well as in some clinical studies. Our initial experience indicates the feasibility of this approach. More clinical studies are required to elucidate its full utility.

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“…Cosmetic satisfaction was evaluated in six studies at different postoperative time-points [15,16,23,28,29,38] and was consistently found to be higher in robotic-assisted thyroidectomy than in open thyroidectomy. Except for two studies reporting significantly less pain in robotic-assisted thyroidectomy on the first 2 postoperative days [26,28], no difference was observed between robotic-assisted thyroidectomy and open thyroidectomy for postoperative pain scores [15,16,24,29] and analgesic requirement [15,24,26] in four other studies. Because of the need of expensive robotic consumables and longer operative time, the cost of robotic-assisted thyroidectomy was found to be 1.5-6.1 times [36,37,39,40] more expensive than open thyroidectomy.…”

Section: Robotic Thyroidectomymentioning

confidence: 81%

“…Posteriorly located tumors [15,21,22,24,26,30], tumors with extrathyroidal invasion [15][16][17][20][21][22]24,29,30,32] and tumors with distant metastases [15][16][17]21,22,29,30,32] are absolute contraindications, while minimal anterior strap muscle invasion is generally not [17,30]. Previous neck surgery, neck irradiation and breast surgery are common absolute contraindications.…”

Section: Robotic Thyroidectomymentioning

confidence: 99%