Transaxillary Robotic Modified Radical Neck Dissection

Abstract

Conventional neck dissection requires a long anterior neck incision and leaves a prominent scar on the neck that can be of great concern to patients (particularly young women) with early thyroid cancer and limited metastasis to one or two lateral neck lymph nodes. Remote-access endoscopic surgery of the thyroid gland has offered the opportunity to reduce the patients’ burden from these surgical scars on the neck [1–3]. In 2007, we successfully performed the first robotic thyroidectomy using a gasless transaxillary approach [4]. The shift toward robotic thyroid surgery has reformed the surgical approach for thyroid disease [5–7]. With the improved ergonomics and shortened learning curve for the new robotic thyroid surgery technique, the field of head and neck surgery has witnessed a revolution in the surgical management of thyroid cancer beyond conventional transaxillary endoscopic thyroid surgery [8, 9]. Moreover, robotic neck dissection has been reported to be a safe and meticulous technique in low-risk patients who have well-differentiated thyroid cancer with lateral neck metastasis and could be an alternative operative method. The transaxillary approach for neck dissection uses a route from the axilla to the anterior neck region; thus, slightly wider flap dissection during robotic thyroid surgery offers a comprehensive operative view and working space for node dissection [10–12]. This chapter describes the latest overview in transaxillary robotic modified radical neck dissection (MRND) techniques for thyroid cancer with limited lateral neck lymph node metastasis.