Springer Nature is making Coronavirus research free. View research | View latest news | Sign up for updates

A novel robotic surgical technique for thyroid surgery: bilateral axillary approach (BAA)



Bilateral axillo-breast approach (BABA) robotic thyroidectomy (RT) is proven to be a feasible method for the treatment of well-differentiated thyroid cancers in terms of oncology as well as cosmesis. However, BABA RT causes postoperative sternal discomfort and needs an incision over the nipple areolar area. Here, we suggest a novel robotic surgical technique for thyroid surgery that does not need a breast incision—bilateral axillary approach (BAA).

Patients and methods

We recruited 51 patients who were willing to undergo the novel BAA robotic thyroid surgery. We performed a propensity score-matched analysis to compare the BAA robotic thyroid surgery group (BAA group) with the conventional open thyroid surgery group (open group).


Mean operation time in the BAA group (129.7 min) was significantly longer than that in the open group (103.1 min) (p < 0.001). However, no significant differences in the mean number of metastatic lymph nodes (LNs), mean number of retrieved LNs, vocal cord palsy, hypoparathyroidism, and mean stimulated thyroglobulin level were observed between the two groups. There was no case of postoperative bleeding or chyle leak. Of the 51 patients who had undergone the BAA procedure, 27 patients answered the questionnaire. The mean scale, ranging from 0 to 10, at postoperative 1 day/2 weeks was as follows: voice change score, 3.0/1.6; swallowing difficulty score, 4.0/2.0; anterior neck pain score, 4.6/3.6; anterior neck numbness score, 5.4/4.3; right chest pain score, 3.8/2.1; left chest pain score, 3.6/2.3; right chest numbness score, 3.2/2.8; left chest numbness score, 2.4/2.7; right breast pain score, 0.9/0; left breast pain score, 1.2/0; right breast numbness score, 1.7/0; and left breast numbness score, 2.6/0, respectively.


BAA robotic thyroid surgery is a novel, safe, and feasible oncoplastic method, especially for patients who have fear of procedures around the nipple areolar complex.

This is a preview of subscription content, log in to check access.

Fig. 1


  1. 1.

    Haugen BRM, Alexander EK, Bible KC, Doherty G, Mandel SJ, Nikiforov YE, Pacini F, Randolph G, Sawka A, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward D, Tuttle RMM, Wartofsky L (2015) 2015 American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer. Thyroid. doi:10.1089/thy.2015.0020

  2. 2.

    Lee KE, Kim E, Koo DH, Choi JY, Kim KH, Youn YK (2013) Robotic thyroidectomy by bilateral axillo-breast approach: review of 1026 cases and surgical completeness. Surg Endosc 27(8):2955–2962. doi:10.1007/s00464-013-2863-1

  3. 3.

    Lee J, Na KY, Kim RM, Oh Y, Lee JH, Lee J, Lee JS, Kim CH, Soh EY, Chung WY (2012) Postoperative functional voice changes after conventional open or robotic thyroidectomy: a prospective trial. Ann Surg Oncol 19(9):2963–2970. doi:10.1245/s10434-012-2253-2

  4. 4.

    Perrier ND, Randolph GW, Inabnet WB, Marple BF, VanHeerden J, Kuppersmith RB (2010) Robotic thyroidectomy: a framework for new technology assessment and safe implementation. Thyroid 20(12):1327–1332. doi:10.1089/thy.2010.1666

  5. 5.

    Inabnet WB 3rd (2012) Robotic thyroidectomy: must we drive a luxury sedan to arrive at our destination safely? Thyroid 22(10):988–990. doi:10.1089/thy.2012.2210.com2

  6. 6.

    Kim SJ, Lee KE, Myong JP, Koo DH, Lee J, Youn YK (2013) Prospective study of sensation in anterior chest areas before and after a bilateral axillo-breast approach for endoscopic/robotic thyroid surgery. World J Surg 37(5):1147–1153. doi:10.1007/s00268-013-1934-8

  7. 7.

    American Thyroid Association Guidelines Taskforce on Thyroid N, Differentiated Thyroid C, Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, Mazzaferri EL, McIver B, Pacini F, Schlumberger M, Sherman SI, Steward DL, Tuttle RM (2009) Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 19(11):1167–1214. doi:10.1089/thy.2009.0110

  8. 8.

    Kang SW, Lee SC, Lee SH, Lee KY, Jeong JJ, Lee YS, Nam KH, Chang HS, Chung WY, Park CS (2009) Robotic thyroid surgery using a gasless, transaxillary approach and the da Vinci S system: the operative outcomes of 338 consecutive patients. Surgery 146(6):1048–1055. doi:10.1016/j.surg.2009.09.007

  9. 9.

    Stang MT, Perrier ND (2013) Robotic thyroidectomy: do it well or don’t do it. JAMA Surg 148(9):806–808. doi:10.1001/jamasurg.2013.2253

  10. 10.

    Hinson AM, Kandil E, O’Brien S, Spencer HJ, Bodenner DL, Hohmann SF, Stack BC Jr (2015) Trends in robotic thyroid surgery in the United States from 2009 through 2013. Thyroid 25(8):919–926. doi:10.1089/thy.2015.0066

  11. 11.

    Perrier ND (2012) Why I have abandoned robot-assisted transaxillary thyroid surgery. Surgery 152(6):1025–1026. doi:10.1016/j.surg.2012.08.060

  12. 12.

    Terris DJ, Duke WS (2013) Robotic and remote access thyroidectomy: a time to pause. World J Surg 37(7):1582–1583. doi:10.1007/s00268-013-2099-1

Download references


Su Jin Ahn, a nurse at the Thyroid Center of Samsung Medical Center, assisted in clinical data collection. We also want to express our special gratitude to Dr. Woo’s wife Min Hye Kim for her infinite understanding and devotion to this work.

Author information

Correspondence to Jee Soo Kim.

Ethics declarations


Jung-Woo Woo, Seo Ki Kim, Inhye Park, Jun Ho Choe, Jung-Han Kim, and Jee Soo Kim have nothing to disclose.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Woo, J., Kim, S.K., Park, I. et al. A novel robotic surgical technique for thyroid surgery: bilateral axillary approach (BAA). Surg Endosc 31, 667–672 (2017).

Download citation


  • Robotic thyroid surgery
  • Robotic thyroidectomy
  • Bilateral axillary approach