A single surgeon's experience and surgical outcomes of 300 robotic thyroid surgeries using a bilateral axillo-breast approach

Abstract

OBJECTIVES: We introduce surgical outcomes regarding 300 cases of robotic thyroidectomy using a bilateral axillo-breast approach (BABA). METHODS: From April 2010 to October 2013, 300 patients who underwent robotic thyroidectomy were analyzed and compared with 300 cases of open total thyroidectomy. Robotic surgery was performed with a snake retractor to allow for complete central lymph node dissection. We performed robotic surgery using BABA without drains in 170 cases; subfascial dissection was performed to reduce post-operative wound adhesion. RESULTS: The learning curve for robotic thyroidectomy was 40 cases; after that, the operation time significantly decreased (233 min vs. 185 min, P=0.001). A snake retractor was selectively useful for the dissection of paratracheal lymph nodes located in the deep areas. In patients who underwent drainless BABA, additional aspirations were required in only 19 (6.3%). The number of retrieved lymph nodes of robot and open surgery were 6.7 ± 0.2 and 8.9 ± 0.3, respectively (P<0.001). The mean serum thyroglobulin of thyroid hormone was 0.80 ± 0.19 and 1.77 ± 0.29 ng/ml, respectively (P=0.001). Post-operative complications of robot surgery, including transient hypocalcemia (n=33, 23.0%) in total thyroidectomy, transient recurrent laryngeal nerve palsy (n=8, 2.6%) without permanent palsy rarely observed. CONCLUSION: Robotic thyroidectomy using BABA is an effective and comparable treatment option. J. Surg. Oncol. 2015 111:135-140.