Surgical Endoscopy

, Volume 28, Issue 11, pp 3134–3142 | Cite as

Factors contributing to surgical outcomes of transaxillary robotic thyroidectomy for papillary thyroid carcinoma

  • Haiyoung Son
  • Seulkee Park
  • Cho Rok Lee
  • Sohee Lee
  • Jung Woo Kim
  • Sang-Wook Kang
  • Jong Ju Jeong
  • Kee-Hyun Nam
  • Woong Youn Chung
  • Cheong Soo Park



Transaxillary robotic thyroidectomy is considered a technically feasible and safe treatment option for patients with low-risk papillary thyroid carcinoma (PTC). The aim of the present study was to determine the factors that contribute to the perioperative surgical outcomes of robotic thyroidectomy and to suggest guidelines for patient selection to be used by surgeons inexperienced in the technique.


We reviewed the records of 275 patients with PTC who underwent robotic total thyroidectomy using a gasless, transaxillary single-incision approach at Yonsei University Health System, South Korea, between January 2011 and May 2012. The association between surgical outcomes and clinicopathologic factors was assessed using linear and logistic regression analysis.


The contributing factors for surgical outcomes of robotic thyroidectomy were categorized as patient factors, including gender and body mass index (BMI), and thyroid-specific factors, including thyroid gland size, coexistent thyroiditis, tumor size, and serum anti-thyroglobulin antibody and anti-microsomal antibody titers. Of these, male gender, a large thyroid gland, and thyroiditis significantly increased the total operation time. Male gender, thyroiditis, and overweight BMI increased the working space time, and a large thyroid gland and overweight BMI affected the console time. A large thyroid gland and histological thyroiditis were associated with increased intraoperative blood loss. There was no association between postoperative complications and clinicopathologic parameters.


Male gender, overweight BMI, a large thyroid gland, and coexistent thyroiditis adversely affected the surgical outcome of robotic thyroidectomy. Surgeons inexperienced in the technique should avoid or carefully approach individuals with these factors.


Robotic thyroidectomy Surgical outcomes Contributing factors Inexperienced surgeon Patient selection 



The authors are grateful to Dong Wook Kim (M.S. in the Biostatistics Collaboration Unit at YUMC) for his help with the statistical analysis.


All authors including S. Lee, Drs Lee, Kim, Park, Lee, Kang, Jeong, Nam, Chung and Park have no conflicts of interest or financial ties to disclose.


  1. 1.
    Lee J, Yun JH, Nam KH, Choi UJ, Chung WY, Soh EY (2011) Perioperative clinical outcomes after robotic thyroidectomy for thyroid carcinoma: a multicenter study. Surg Endosc 25(3):906–912PubMedCrossRefGoogle Scholar
  2. 2.
    Ryu HR, Kang SW, Lee SH et al (2010) Feasibility and safety of a new robotic thyroidectomy through a gasless, transaxillary single-incision approach. J Am Coll Surg 211(3):e13–e19PubMedCrossRefGoogle Scholar
  3. 3.
    Lobe TE, Wright SK, Irish MS (2005) Novel uses of surgical robotics in head and neck surgery. J Laparoendosc Adv Surg Tech A 15(6):647–652PubMedCrossRefGoogle Scholar
  4. 4.
    Miyano G, Lobe TE, Wright SK (2008) Bilateral transaxillary endoscopic total thyroidectomy. J Pediatr Surg 43(2):299–303PubMedCrossRefGoogle Scholar
  5. 5.
    Lee S, Ryu HR, Park JH et al (2011) Excellence in robotic thyroid surgery: a comparative study of robot-assisted versus conventional endoscopic thyroidectomy in papillary thyroid microcarcinoma patients. Ann Surg 253(6):1060–1066PubMedCrossRefGoogle Scholar
  6. 6.
    Kang SW, Lee SC, Lee SH et al (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):1048–1055PubMedCrossRefGoogle Scholar
  7. 7.
    Kang SW, Jeong JJ, Yun JS et al (2009) Robot-assisted endoscopic surgery for thyroid cancer: experience with the first 100 patients. Surg Endosc 23(11):2399–2406PubMedCrossRefGoogle Scholar
  8. 8.
    Kang SW, Park JH, Jeong JS et al (2011) Prospects of robotic thyroidectomy using a gasless, transaxillary approach for the management of thyroid carcinoma. Surg laparosc endosc percutan tech 21(4):223–229PubMedCrossRefGoogle Scholar
  9. 9.
    Lee S, Park S, Lee CR et al (2013) The impact of body habitus on the surgical outcomes of transaxillary single-incision robotic thyroidectomy in papillary thyroid carcinoma patients. Surg Endosc 27(7):2407–2414PubMedCrossRefGoogle Scholar
  10. 10.
    Kang SW, Jeong JJ, Nam KH, Chang HS, Chung WY, Park CS (2009) Robot-assisted endoscopic thyroidectomy for thyroid malignancies using a gasless transaxillary approach. J Am Coll Surg 209(2):e1–e7PubMedCrossRefGoogle Scholar
  11. 11.
    Noureldine SI, Abdelghani R, Saeed A et al (2013) Is robotic hemithyroidectomy comparable to its conventional counterpart? Surgery 154(2):363–368PubMedCrossRefGoogle Scholar
  12. 12.
    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(4):558–564 discussion 564–556PubMedCrossRefGoogle Scholar
  13. 13.
    Inabnet WB 3rd (2012) Robotic thyroidectomy: must we drive a luxury sedan to arrive at our destination safely? Thyroid 22(10):988–990PubMedCrossRefGoogle Scholar
  14. 14.
    Kang SW, Lee SH, Ryu HR et al (2010) Initial experience with robot-assisted modified radical neck dissection for the management of thyroid carcinoma with lateral neck node metastasis. Surgery 148(6):1214–1221PubMedCrossRefGoogle Scholar
  15. 15.
    Kang SW, Jeong JJ, Yun JS et al (2009) Gasless endoscopic thyroidectomy using trans-axillary approach; surgical outcome of 581 patients. Endocr J 56(3):361–369PubMedCrossRefGoogle Scholar
  16. 16.
    Lee S, Lee CR, Lee SC et al (2013) Surgical completeness of robotic thyroidectomy: a prospective comparison with conventional open thyroidectomy in papillary thyroid carcinoma patients. Surgical endoscGoogle Scholar
  17. 17.
    Ryu HR, Lee J, Park JH et al (2013) A comparison of postoperative pain after conventional open thyroidectomy and transaxillary single-incision robotic thyroidectomy: a prospective study. Ann Surg Oncol 20(7):2279–2284PubMedCrossRefGoogle Scholar
  18. 18.
    Lee S, Park S, Lee CR et al (2013) The impact of body habitus on the surgical outcomes of transaxillary single-incision robotic thyroidectomy in papillary thyroid carcinoma patients. Surg endosc 27(7):2407–2414PubMedCrossRefGoogle Scholar
  19. 19.
    Welbourn RB (1996) Highlights from endocrine surgical history. World J Surg 20(5):603–612PubMedCrossRefGoogle Scholar
  20. 20.
    Lee S, Ryu HR, Park JH et al (2012) Early surgical outcomes comparison between robotic and conventional open thyroid surgery for papillary thyroid microcarcinoma. Surgery 151(5):724–730PubMedCrossRefGoogle Scholar
  21. 21.
    Lee J, Nah KY, Kim RM, Ahn YH, Soh EY, Chung WY (2010) Differences in postoperative outcomes, function, and cosmesis: open versus robotic thyroidectomy. Surg Endosc 24(12):3186–3194PubMedCrossRefGoogle Scholar
  22. 22.
    Yoon JH, Park CH, Chung WY (2006) Gasless endoscopic thyroidectomy via an axillary approach: experience of 30 cases. Surg Laparosc Endosc Percutan Tech 16(4):226–231PubMedCrossRefGoogle Scholar
  23. 23.
    Jeong JJ, Kang SW, Yun JS et al (2009) Comparative study of endoscopic thyroidectomy versus conventional open thyroidectomy in papillary thyroid microcarcinoma (PTMC) patients. J Surg Oncol 100(6):477–480PubMedCrossRefGoogle Scholar
  24. 24.
    Lee J, Kang SW, Jung JJ et al (2011) Multicenter study of robotic thyroidectomy: short-term postoperative outcomes and surgeon ergonomic considerations. Ann Surg Oncol 18(9):2538–2547PubMedCrossRefGoogle Scholar
  25. 25.
    Yi O, Yoon JH, Lee YM et al (2013) Technical and oncologic safety of robotic thyroid surgery. Ann Surg Oncol 20(6):1927–1933PubMedCrossRefGoogle Scholar
  26. 26.
    Tae K, Kim KY, Yun BR et al (2012) Functional voice and swallowing outcomes after robotic thyroidectomy by a gasless unilateral axillo-breast approach: comparison with open thyroidectomy. Surg Endosc 26(7):1871–1877PubMedCrossRefGoogle Scholar
  27. 27.
    Lee J, Na KY, Kim RM et al (2012) Postoperative functional voice changes after conventional open or robotic thyroidectomy: a prospective trial. Ann Surg Oncol 19(9):2963–2970PubMedCrossRefGoogle Scholar
  28. 28.
    Kuppersmith RB, Holsinger FC (2011) Robotic thyroid surgery: an initial experience with North American patients. Laryngoscope 121(3):521–526PubMedCrossRefGoogle Scholar
  29. 29.
    Holsinger FC, Terris DJ, Kuppersmith RB (2010) Robotic thyroidectomy: operative technique using a transaxillary endoscopic approach without CO2 insufflation. Otolaryngol Clin North Am 43(2):381–388 ix-xPubMedCrossRefGoogle Scholar
  30. 30.
    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):1327–1332PubMedCrossRefGoogle Scholar
  31. 31.
    Brunaud L, Germain A, Zarnegar R, Klein M, Ayav A, Bresler L (2010) Robotic thyroid surgery using a gasless transaxillary approach: cosmetic improvement or improved quality of surgical dissection? J Visc Surg 147(6):e399–e402PubMedCrossRefGoogle Scholar
  32. 32.
    Landry CS, Grubbs EG, Warneke CL et al (2012) Robot-assisted transaxillary thyroid surgery in the United States: is it comparable to open thyroid lobectomy? Ann Surg Oncol 19(4):1269–1274PubMedCrossRefGoogle Scholar
  33. 33.
    Seybt M, Kuppersmith RB, Holsinger FC, Terris DJ (2010) Robotic axillary thyroidectomy: multi-institutional clinical experience with the daVinci. Laryngoscope 120(Suppl 4):S182PubMedCrossRefGoogle Scholar
  34. 34.
    Stevenson CE, Gardner DF, Grover AC (2012) Patient factors affecting operative times for single-incision trans-axillary robotic-assisted (STAR) thyroid lobectomy: does size matter? Ann Surg Oncol 19(5):1460–1465PubMedCrossRefGoogle Scholar
  35. 35.
    McManus C, Luo J, Sippel R, Chen H (2012) Is thyroidectomy in patients with Hashimoto thyroiditis more risky? J Surg Res 178(2):529–532PubMedCrossRefPubMedCentralGoogle Scholar
  36. 36.
    Hofling DB, Chavantes MC, Juliano AG et al (2012) Assessment of the effects of low-level laser therapy on the thyroid vascularization of patients with autoimmune hypothyroidism by color Doppler ultrasound. ISRN endocrinol 2012:126720PubMedCrossRefPubMedCentralGoogle Scholar
  37. 37.
    Willms A, Bieler D, Wieler H, Willms D, Kaiser KP, Schwab R (2013) Correlation between sonography and antibody activity in patients with hashimoto thyroiditis. J Ultrasound Med 32(11):1979–1986PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Haiyoung Son
    • 1
  • Seulkee Park
    • 2
  • Cho Rok Lee
    • 4
  • Sohee Lee
    • 3
  • Jung Woo Kim
    • 4
  • Sang-Wook Kang
    • 4
  • Jong Ju Jeong
    • 4
  • Kee-Hyun Nam
    • 4
  • Woong Youn Chung
    • 4
  • Cheong Soo Park
    • 4
  1. 1.Department of SurgeryInternational St. Mary’s HospitalIncheon Metropolitan CityRepublic of Korea
  2. 2.Department of SurgeryEulji General Hospital, Eulji University School of MedicineSeoulRepublic of Korea
  3. 3.Department of SurgeryThe Catholic University of Korea College of MedicineSeocho-guRepublic of Korea
  4. 4.Department of SurgeryYonsei University Health SystemSeoulRepublic of Korea

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