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

Abstract

Introduction

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).

Results

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.

Conclusion

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.

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Acknowledgments

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.

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Disclosures

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

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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). https://doi.org/10.1007/s00464-016-5018-3

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Keywords

  • Robotic thyroid surgery
  • Robotic thyroidectomy
  • Bilateral axillary approach