Single Surgeon Experience with 500 Cases of the Robotic Bilateral Axillary Breast Approach (BABA) for Thyroid Surgery Using the Da-Vinci Xi System

Abstract

Objectives: Robotic bilateral axillary breast approach (BABA) thyroid surgery began in 2008 and is now one of the most widely used remote-access thyroid surgeries worldwide. This study aimed to analyze the results of 500 robotic BABA thyroid surgeries performed in a single institution in Korea compared with open thyroid surgery. Methods: From December 2018 to March 2020, 502 robotic BABA thyroidectomies (RTs) and 531 conventional open thyroidectomies (OTs) were performed in our institution by a single endocrine surgeon. We retrospectively reviewed patient medical records and performed a comparative analysis of OT and RT. Results: The RT group was younger (43.41 ± 11.41 versus 54.28 ± 13.41 years, p < 0.001) and had a higher proportion of females (84.3% versus 69.3%, p < 0.001), a lower BMI (24.66 ± 3.97 versus 25.83 ± 4.07 kg/m2), a higher proportion of lobectomies (52.6% versus 45.2%) and a lower proportion of lateral neck dissections (3.4% versus 10.0%, p < 0.001). The RT group had a longer operation time (145.33 ± 40.80 versus 93.39 ± 43.55 min, p < 0.001) and higher surgical costs. Although the OT group had a larger tumor size and a higher proportion of extrathyroidal extension, the numbers of retrieved lymph nodes were not significantly different between the two groups. Additionally, there was no difference in the stimulated thyroglobulin level before radioactive iodine therapy (7.01 ± 35.73 versus 8.39 ± 58.77, p = 0.782). The rates of transient vocal cord palsy and transient hypoparathyroidism were significantly lower in the RT group, and those of scar-related complications were higher in the OT group. Conclusions: Robotic BABA thyroid surgery has advantages not only in better cosmetic outcomes but also in lower rates of vocal cord palsy and hypoparathyroidism, with comparable lymph node retrieval and serum thyroglobulin levels.

Surgical outcomes of robotic thyroidectomy for thyroid tumors over 4 cm via the bilateral axillo-breast approach

“…Since introduction of robotic BABA thyroidectomy in 2008, robotic BABA thyroidectomy has become one of the most remarkable remote-access approaches globally, particularly in Korea 11 . Over time, many surgeons have demonstrated the safety of robotic BABA thyroidectomy and have tried to overcome existing surgical criteria 8,[14][15][16] . A recent study also suggested that surgical indications might extend up to 4 cm for malignant tumors and up to 8 cm for benign nodules 17 .…”

Techniques for Thyroidectomy and Functional Neck Dissection

“…The approach of the procedure is chosen based on the patient anatomy, the extent of the disease, and cosmetic preferences. In recent times, the robotic thyroidectomy technique that has been predominantly favored and implemented is the bilateral axillo-breast approach [70]. A study including 500 patients undergoing the robotic BABA revealed that the rate of transient vocal cord palsy and hypoparathyroidism is significantly lower compared to open thyroidectomy [70].…”

“…In recent times, the robotic thyroidectomy technique that has been predominantly favored and implemented is the bilateral axillo-breast approach [70]. A study including 500 patients undergoing the robotic BABA revealed that the rate of transient vocal cord palsy and hypoparathyroidism is significantly lower compared to open thyroidectomy [70]. Moreover, the BABA has emerged as a more conducive technique for total thyroidectomies and the excision of large goiters compared to the transaxillary approach, which is attributed to its enhanced anatomical accessibility and the precision facilitating the comprehensive removal of the thyroid gland [71,72].…”