Background: Robotic thyroid operation using the gasless transaxillary approach is an applicable and safe method providing a scarless in the neck result in selected patients. The application of robotic technology offer a three-dimensional view and tremor free movements which enable a potential advantage in recurrent laryngeal nerve and parathyroid glands preservation.
Patients and methods: Seven patients with history of bad scars from previous surgeries underwent robot-assisted endoscopic thyroid operations using the gasless transaxillary approach. All the operations were performed using the Da Vinci S surgical robotic system. The preoperative evaluation of thyroid pathology consisted in ultrasound examination and FNA biopsy. In all cases we performed laryngoscopy to examine the vocal cords function preoperatively and postoperatively. Patients clinicopathologic data, operation times, postoperative hospital stays, complications, conversions, postoperative pain and cosmetic results were all analyzed.
Results: The mean patient age was 41.6 years (range 3056).
Two patients had papillary carcinoma; one had toxic adenoma and four multinodular disease. Three totals, one lobectomy and three near total thyroidectomies were performed. Mean diameter of the largest nodule was 27.2 mm (range 1820). No conversions occurred.
Four patients complained about hypoesthesia in the flap dissection area whereas two presented mild seroma. Transient hypocalcaemia occurred in two patients and one had a temporary recurrent laryngeal nerve paralysis, which improved gradually.
The total operation time was177 min (range 120250) and consisted of a mean 34 min (range 2040) working space time, a mean 21 min (range 1030) docking time and a mean 122 min (range 70210) console time.
Mean hospital stay was 1.6 days (range 13). Postoperative pain was minimal and the cosmetic result excellent.
Conclusions: Our initial experience shows that the robot assisted gasless transaxillary approach is feasible and provides safe excision of thyroid pathology, an easy identification of the vital structures with the perfect aesthetic outcome of a scarless neck.
Prague, Czech Republic
24 - 28 Apr 2010
European Society of Endocrinology