Robotic Thyroidectomy: An Initial Experience with the Gasless Transaxillary Approach

Background: Thyroid surgery has recently emerged as one of the most promising fields for the application of robotic surgery. We report the results of the first year of experience with a gasless transaxillary thyroidectomy. Subjects and Methods: From January 2009 to December 2009, 10 consecutive patients (8 women) underwent robotic thyroidectomy through a gasless transaxillary approach. The median age was 44 years (range, 27-42 years). Eight total and two partial thyroidectomies (one left and one right) were performed using the da Vinci (R) Robotic Surgical System (Intuitive Surgical, Sunnyvale, CA). Preoperative diagnosis included solitary nodules with a median size of 16 -11mm (range, 3-44 mm) at preoperative imaging. Results: All procedures were successfully completed robotically, except one that was converted because of difficulty in achieving an optimal exposure. The overall mean operative time was 177.4 +/- 40 minutes (range, 120-240 minutes) with minimal blood loss (<10mL). Pathological diagnoses included papillary carcinoma (n = 6), colloid nodule (n = 2), and multinodular goiter (n = 2). The mean number of lymph nodes harvested in the cases of malignant disease was 4 +/- 5 (range, 3-15). The median postoperative length of stay was 1.05 days (range, 1-1.4 days). Conclusions: Thyroid surgery using a gasless transaxillary approach can be performed safely for selected benign and malignant pathology. This approach offers superior cosmetic results and a short hospital stay over conventional thyroid surgery. For selected patients, this technique offers a promising scarless option for minimally invasive thyroid surgery.