Gasless Transaxillary Robotic vs Endoscopic Thyroidectomy: Exploring the Frontiers of Scarless Thyroidectomy Through a Preliminary Comparison Study

Andreas Kiriakopoulos, MD, Dimitrios Linos, MD. Department of Surgery, Hygeia Hospital, Athens, Greece


Aim: Robotic – assisted thyroidectomy has been inadvertently associated with lengthy operative times mainly due to fussy robot preparation and docking maneuvers. We propose a purely endoscopic approach using a novel platform comparing its results with the former approach
Patients and Methods: 8 patients (6 females and 2 males, mean age 38.8 yrs, range: 30-56) having favorable body habitus (mean BMI 23.4, range: 18-30) underwent robotic-assisted thyroidectomy through a gasless transaxillary approach using the da Vinci S surgical robot system. Another 4 female patients (mean age 31 yrs, range: 27-43) underwent a purely endoscopic method. Skin flap dissection and gasless thyroidectomy comprised the common operative steps in both procedures. Robotic thyroidectomy necessitated an additional robot docking maneuver. Patient’s demographic data, operative time, complications, conversions, hospital stay and postoperative pain VAPS are compared.
Results: 3 lobectomies, 2 near-totals, 2 totals and one total thyroidectomy with lateral lymph node dissection have been performed in the robotic group. 2 lobectomies and 2 near total thyroidectomies were performed in the endoscopic group. Mean diameter of the largest nodule in the robotic series was 26.5 mm (range: 18-60) vs 42.5 mm (range: 35-55) in the endoscopic group. Mean total operative time was 211 min (range: 165-250) for the robot {consisting of a mean 32 min (range: 20-40) flap dissection time, a mean 13 min (range: 10-20) docking time and a 166 min (range: 130-210) console time} vs 160 min (range: 100-190) for the endoscopic series. We had no conversions in both procedures and a drain was left in place in all patients. We had one temporary recurrent laryngeal nerve paralysis in the robotic group. Two patients from the robotic group exhibited transient symptomatic hypocalcemia vs 1 from the other group. Hypoesthesia/disturbed sensation in the flap dissection area was referred by 3 patients of the robotic and two patients of the endoscopic groups. Mean hospital stay was 1.5 days (range: 1-3) for both groups. Postoperative pain was also similar in both groups.
Conclusions: Our preliminary comparison shows that robotic-assisted and purely endoscopic transaxillary approaches are safe, feasible and are associated with similar results. Both applications give excellent view of the critical neck anatomy that allows precise tissue handling and dissection. However, the endoscopic approach results in a significantly faster and more convenient thyroidectomy

Session Number: SS07 – Solid Organ
Program Number: S041

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