Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Transaxillary robotic modified radical neck dissection: a 5-year assessment of operative and oncologic outcomes

  • 421 Accesses

  • 13 Citations



Robotic modified radical neck dissection (MRND) using a gasless transaxillary approach has been reported to be a safe and meticulous technique in patients with papillary thyroid carcinoma (PTC) and lateral neck node metastasis (N1b). Few studies, however, have attempted to assess the long-term oncologic outcomes of robotic MRND in these patients. This study aimed to compare perioperative and 5-year oncologic outcomes of robotic MRND with conventional open procedures in patients with N1b PTC.


Between September 2007 and February 2010, 193 patients with N1b PTC underwent total thyroidectomy and MRND by a single surgeon. Of these, 42 (21.8 %) underwent robotic procedures and 151 (78.2 %) underwent conventional open procedures. All patients received 3.7- to 5.5-GBq radioactive iodine (RAI) ablation, post-therapy whole-body scans (TxWBSs), and diagnostic WBS (DxWBSs) during follow-up. An exact 1:3 matching for age and stage was performed to minimize selection bias, and perioperative and 5-year oncologic outcomes were compared in the matched groups.


The mean follow-up period was 66.0 months (range 60–90 months). Number of retrieved cervical lymph nodes (LNs) (p = .102) and postoperative ablation success rates (p = .864) were similar between the two groups. TSH-suppressed serum Tg concentrations after 5 years (0.7 ± 1.5 vs. 2.4 ± 14.1 ng/ml; p = .471) and recurrence rates in the robotic and open groups (1/41 [2.4 %] vs. 3/102 [2.9 %]; p = .864) were similar for the 5-year follow-up period. Four patients experienced recurrence: Three exhibited regional lymph node metastasis, and one showed bilateral lung metastases.


The perioperative and 5-year oncologic outcomes were similar after robotic and conventional open MRND. Large, prospective randomized controlled trials with long-term follow-up data are needed to validate these results.

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

Fig. 1


  1. 1.

    Jung KW, Won YJ, Kong HJ, Oh CM, Seo HG, Lee JS (2013) Cancer statistics in Korea: incidence, mortality, survival and prevalence in 2010. Cancer Res Treatm Off J Korean Cancer Assoc 45:1–14

  2. 2.

    Karakoc D, Ozdemir A (2010) Lymph node surgery in papillary thyroid carcinoma. Int Surg 95:142–146

  3. 3.

    Nam IC, Park JO, Joo YH, Cho KJ, Kim MS (2013) Pattern and predictive factors of regional lymph node metastasis in papillary thyroid carcinoma: a prospective study. Head Neck 35:40–45

  4. 4.

    Kim YS (2012) Patterns and predictive factors of lateral lymph node metastasis in papillary thyroid microcarcinoma. Otolaryngol Head Neck Surg Off J Am Acad Otolaryngol Head Neck Surg 147:15–19

  5. 5.

    Lim YS, Lee JC, Lee YS, Lee BJ, Wang SG, Son SM, Kim IJ (2011) Lateral cervical lymph node metastases from papillary thyroid carcinoma: predictive factors of nodal metastasis. Surgery 150:116–121

  6. 6.

    Kumar S, Burgess C, Moorthy R (2013) The extent of lateral lymph node dissection in differentiated thyroid cancer in the N + neck. Eur Arch Oto-Rhino-Laryngology Off J Eur Fed Oto-Rhino-Laryngology Soc EUFOS Affil German Soc Oto-Rhino-Laryngology Head Neck Surg 270:2947–2952

  7. 7.

    Caron NR, Clark OH (2005) Papillary thyroid cancer: surgical management of lymph node metastases. Curr Treat Options Oncol 6:311–322

  8. 8.

    Zhang ZM, Xu ZG, Li ZJ, An CM, Liu J, Zhu YM, Ni S, Tang PZ (2013) Minimally invasive endoscopy-assisted neck dissection to treat lateral cervical metastasis of thyroid papillary carcinoma. Zhonghua er bi yan hou tou jing wai ke za zhi Chin J Otorhinolaryngol Head Neck Surg 48:712–715

  9. 9.

    Huang XM, Sun W, Hong Y, Cai Q, Liang FY, Han P (2012) Minimally invasive endoscopic thyroidectomy via an anterior chest approach for early papillary thyroid cancer. Zhonghua er bi yan hou tou jing wai ke za zhi Chin J Otorhinolaryngol Head Neck Surg 47:571–574

  10. 10.

    Lombardi CP, Raffaelli M, Princi P, De Crea C, Bellantone R (2007) Minimally invasive video-assisted functional lateral neck dissection for metastatic papillary thyroid carcinoma. Am J Surg 193:114–118

  11. 11.

    Moore EJ, Price DL (2011) Robotic surgery for head and neck cancer. Minn Med 94:37–41

  12. 12.

    Kang SW, Lee SH, Park JH, Jeong JS, Park S, Lee CR, Jeong JJ, Nam KH, Chung WY, Park CS (2012) A comparative study of the surgical outcomes of robotic and conventional open modified radical neck dissection for papillary thyroid carcinoma with lateral neck node metastasis. Surg Endosc 26:3251–3257

  13. 13.

    Kang SW, Lee SH, Ryu HR, Lee KY, Jeong JJ, Nam KH, Chung WY, Park CS (2010) Initial experience with robot-assisted modified radical neck dissection for the management of thyroid carcinoma with lateral neck node metastasis. Surgery 148:1214–1221

  14. 14.

    Lee J, Kwon IS, Bae EH, Chung WY (2013) Comparative analysis of oncological outcomes and quality of life after robotic versus conventional open thyroidectomy with modified radical neck dissection in patients with papillary thyroid carcinoma and lateral neck node metastases. J Clin Endocrinol Metab 98:2701–2708

  15. 15.

    Kandil EH, Noureldine SI, Yao L, Slakey DP (2012) Robotic transaxillary thyroidectomy: an examination of the first one hundred cases. J Am Coll Surg 214:558–564 (discussion 564–556)

  16. 16.

    Cisco RM, Shen WT, Gosnell JE (2012) Extent of surgery for papillary thyroid cancer: preoperative imaging and role of prophylactic and therapeutic neck dissection. Curr Treat Options Oncol 13:1–10

  17. 17.

    Kim MJ, Kim EK, Kim BM, Kwak JY, Lee EJ, Park CS, Cheong WY, Nam KH (2009) Thyroglobulin measurement in fine-needle aspirate washouts: the criteria for neck node dissection for patients with thyroid cancer. Clin Endocrinol 70:145–151

  18. 18.

    Sohn YM, Kim MJ, Kim EK, Kwak JY (2012) Diagnostic performance of thyroglobulin value in indeterminate range in fine needle aspiration washout fluid from lymph nodes of thyroid cancer. Yonsei Med J 53:126–131

  19. 19.

    Caron NR, Tan YY, Ogilvie JB, Triponez F, Reiff ES, Kebebew E, Duh QY, Clark OH (2006) Selective modified radical neck dissection for papillary thyroid cancer—Is level I, II and V dissection always necessary? World J Surg 30:833–840

  20. 20.

    Lee J, Sung TY, Nam KH, Chung WY, Soh EY, Park CS (2008) Is level IIb lymph node dissection always necessary in N1b papillary thyroid carcinoma patients? World J Surg 32:716–721

  21. 21.

    Webb RC, Howard RS, Stojadinovic A, Gaitonde DY, Wallace MK, Ahmed J, Burch HB (2012) The utility of serum thyroglobulin measurement at the time of remnant ablation for predicting disease-free status in patients with differentiated thyroid cancer: a meta-analysis involving 3947 patients. J Clin Endocrinol Metab 97:2754–2763

  22. 22.

    Lee S, Lee CR, Lee SC, Park S, Kim HY, Son H, Kang SW, Jeong JJ, Nam KH, Chung WY, Park CS, Cho A (2014) Surgical completeness of robotic thyroidectomy: a prospective comparison with conventional open thyroidectomy in papillary thyroid carcinoma patients. Surg Endosc 28:1068–1075

  23. 23.

    Rivere AE, Brooks AJ, Hayek GA, Wang H, Corsetti RL, Fuhrman GM (2014) Parathyroid hormone levels predict posttotal thyroidectomy hypoparathyroidism. Am Surg 80:817–820

  24. 24.

    Kosanke J, Bergstralh E (2004) Match one or more controls to cases using the GREEDY algorithm. Mayo Clinic College of Medicine, Rochester, MN

  25. 25.

    Kang SW, Jeong JJ, Yun JS, Sung TY, Lee SC, Lee YS, Nam KH, Chang HS, Chung WY, Park CS (2009) Gasless endoscopic thyroidectomy using trans-axillary approach; surgical outcome of 581 patients. Endocr J 56:361–369

  26. 26.

    Miccoli P, Materazzi G, Berti P (2010) Minimally invasive thyroidectomy in the treatment of well differentiated thyroid cancers: indications and limits. Curr Opin Otolaryngol Head Neck Surg 18:114–118

  27. 27.

    Giannopoulos G, Kang SW, Jeong JJ, Nam KH, Chung WY (2013) Robotic thyroidectomy for benign thyroid diseases: a stepwise strategy to the adoption of robotic thyroidectomy (gasless, transaxillary approach). Surg Laparosc Endos Percutaneous Tech 23:312–315

  28. 28.

    Kang SW, Park JH, Jeong JS, Lee CR, Park S, Lee SH, Jeong JJ, Nam KH, Chung WY, Park CS (2011) Prospects of robotic thyroidectomy using a gasless, transaxillary approach for the management of thyroid carcinoma. Surg Laparosc Endos Percutaneous Tech 21:223–229

  29. 29.

    Hennessy S, Bilker WB, Berlin JA, Strom BL (1999) Factors influencing the optimal control-to-case ratio in matched case–control studies. Am J Epidemiol 149:195–197

  30. 30.

    Lee KE, Koo do H, Im HJ, Park SK, Choi JY, Paeng JC, Chung JK, Oh SK, Youn YK (2011) Surgical completeness of bilateral axillo-breast approach robotic thyroidectomy: comparison with conventional open thyroidectomy after propensity score matching. Surgery 150:1266–1274

Download references


This study was supported by a faculty research grant from Yonsei University College of Medicine for 2015 (6-2015-0056) (to WY Chung) and Intuitive Surgical Clinical Robotics Research Grant (to W.Y. Chung and J. Lee).

Author information

Correspondence to Woong Youn Chung.

Ethics declarations


Min Jhi Kim, Jandee Lee, Seul Gi Lee, Jung Bum Choi, Tae Hyung Kim, Eun Jeong Ban, Cho Rok Lee, Sang-Wook Kang, Jong Ju Jeong, Kee-Hyun Nam, Young Suk Jo, and Woong Youn Chung have no conflicts of interest or financial ties to disclose.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Kim, M.J., Lee, J., Lee, S.G. et al. Transaxillary robotic modified radical neck dissection: a 5-year assessment of operative and oncologic outcomes. Surg Endosc 31, 1599–1606 (2017). https://doi.org/10.1007/s00464-016-5146-9

Download citation


  • Papillary thyroid cancer
  • Lateral neck node metastasis
  • Robotic surgery
  • Modified radical neck dissection
  • Oncologic outcome