Robot-Assisted Transaxillary Hemi-Thyroidectomy for Large Right Side Goiter

Pier C Giulianotti, Francesco M Bianco, Nicolas C Buchs, Subhashini M Ayloo. University of Illinois at Chicago

Thyroid surgery seems one of the most promising fields for the application of robotic surgery. However, relatively strict selection criteria are currently used notably concerning the size of the lesion. With our growing experience, we performed a robot-assisted transaxillary hemi-thyroidectomy for a large right side goiter (7 cm) using the UIC retractor. The objective of this video is to describe this new technique and approach.

A 31-year old woman was referred to our clinic for a thyroid nodule. She has had general malaise for the past 2 months with palpitations, dysphagia for the past 3 weeks and 20lb weight loss over the past month. An ultrasound showed an enlarged right lobe (6.9 x 2.9 x 3.6 cm) with a smaller hypoechoic nodular density (1.6 x 1.5 x 1.4 cm). A fine needle aspiration of the right lobe under ultrasound revealed benign follicular cells.
This video presentation showcases step by step technical details of this new approach.

A right transaxillary approach was performed under general anesthesia. A short incision of about 5-6 cm is placed and a prepectoral tunnel was created until the two heads of the sternocleidomastoid muscle are visualized. The UIC retractor was placed in position in order to elevate the central part of the sternocleidomastoid muscle and to expose the thyroid. The fourth arm of the robotic trocar was placed on chest and the three others arms including the scope were placed through the small incision. The lateral dissection of the right thyroid lobe was performed first with the harmonic scalpel. After recognition of the laryngeal nerve and parathyroid glands, the inferior thyroid vascular pedicles were controlled. Because of the benignity of the case, the thyroid isthmus was then divided, allowing a better exposure of the upper thyroid pole. With the retraction by the assistant, the upper thyroid vascular pedicle was divided using the harmonic scalpel.
The specimen was removed and the hemostasis was controlled. The mean operative time was 120 minutes. The blood loss was minimal and the postoperative course was uneventful.

This video highlights the technical details of robot-assisted transaxillary hemi-thyroidectomy for a benign but large goiter. This approach offers a better cosmesis than the traditional open thyroid surgery.

Session: SS17
Program Number: V043

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