Safety and Feasibility of Single-Port Trans-Axillary Robotic Thyroidectomy: Experience through Consecutive 100 Cases

Abstract

Background and Objectives: Recently, the single-port (SP) robotic system was introduced for minimally invasive operative techniques. Thus, this study aimed to validate the safety and feasibility of SP trans-axillary robotic thyroidectomy (SP-TART) through experiences in a single tertiary institution. Materials and Methods: This study retrospectively analyzed 100 consecutive patients who underwent SP-TART from October 2021 to June 2022 in Seoul St. Mary’s Hospital in Seoul, Korea. We analyzed the clinicopathological characteristics and perioperative outcomes, including complications. Results: Less than total thyroidectomy (LTT) was performed in 81, total thyroidectomy (TT) in 16, and TT with modified radical neck dissection (mRND) in 3 patients. The mean operation time (min) was 53.3 ± 13.7, 86.3 ± 15.1, and 245.7 ± 36.7 in LTT, TT, and TT with mRND, respectively. The mean postoperative hospital stay was 2.0 ± 0.2, 2.1 ± 0.3, and 3.7 ± 1.5 days, respectively. A total of 84 cases of thyroid cancer were included, and 97.6% of them (82 cases) were papillary carcinoma and the rest were follicular and poorly differentiated carcinomas. Regarding complications, five cases had major complications, including three cases of vocal cord palsy and two cases of transient hypoparathyroidism. Conclusions: SP-TART is safe and feasible with a short operation time and a short length of hospital stay.

Clinical status and future prospects of single-incision robotic assisted surgery (SIRAS): A review

“…These operations were performed via four robotic trocars arranged in the single incision, with one 12 mm trocar for 30-degree dual-camera endoscope, one 8 mm trocar for grasper, and two 5 mm trocars for energy device and dissector, respectively. According to previous studies (Table 3 ) 97 – 112 , the main advantages of START are ease of console stage, ease of detecting the recurrent laryngeal nerve, ability to perform total thyroidectomy with central and lateral neck dissections for advanced cancer 104 , 106 , 113 , 114 , and more favorable postoperative swallowing function than conventional open thyroidectomy 98 , 113 – 115 , as well as recognized safety and feasibility 105 , 110 . Especially for oncologic outcomes, Kim et al 112 summarized their experience of 5000 cases of START from October 2007 to May 2016 in a retrospective study, and reported no disease-specific mortality and a median recurrence-free survival of 52.5±27.1 months.…”