Surgical Endoscopy

, Volume 34, Issue 2, pp 622–627 | Cite as

Comparison of robot-assisted modified radical neck dissection using a bilateral axillary breast approach with a conventional open procedure after propensity score matching

  • Se Hyun Paek
  • Hye Ah Lee
  • Hyungju Kwon
  • Kyung Ho KangEmail author
  • Sung Jun Park



There is ongoing debate about whether or not robot-assisted thyroidectomy is appropriate for modified radical neck dissection (MRND). The purpose of this study was to compare the surgical outcomes of robot-assisted MRND with those of a conventional open procedure.


One hundred and forty-five patients who underwent total thyroidectomy, bilateral central neck dissection, and MRND (robotic, n = 28; open, n = 117) at our institution from June 2011 to June 2015 were enrolled in the study. The surgical completeness and complication rates in the robotic and open groups were retrospectively compared after 1:3 propensity score matching for age, sex, body mass index, tumor size, and extrathyroidal extension.


The complication rates, including transient or permanent hypoparathyroidism and recurrent laryngeal nerve palsy, were comparable between the study groups (p > 0.05). The operating time was significantly longer in the robotic group than in the open group (p < 0.001). There was no significant difference in the number of retrieved lymph nodes, metastatic lymph nodes, or stimulated serum thyroglobulin level between the two groups (p = 0.733, p = 0.663, and p = 0.285, respectively).


The surgical outcomes, including complication and completeness rates, were comparable between robot-assisted MRND using a bilateral axillary breast approach and conventional open surgery. Robot-assisted MRND can be recommended as an alternative to a conventional open procedure for thyroidectomy.


Bilateral axillary breast approach da Vinci robot Modified radical neck dissection Propensity score matching Thyroidectomy 


Compliance with ethical standards


Drs. Se Hyun Paek, Hye Ah Lee, Hyungju Kwon, Kyung Ho Kang, and Sung Jun Park have no conflicts of interest or financial ties to disclose.


  1. 1.
    Kang SW, Jeong JJ, Yun JS, Sung TY, Lee SC, Lee YS, Nam KH, Chang HS, Chung WY, Park CS (2009) Robot-assisted endoscopic surgery for thyroid cancer: experience with the first 100 patients. Surg Endosc 23:2399–2406CrossRefGoogle Scholar
  2. 2.
    Lee KE, Rao J, Youn YK (2009) Endoscopic thyroidectomy with the da Vinci robot system using the bilateral axillary breast approach (BABA) technique: our initial experience. Surg Laparosc Endosc Percutaneous Tech 19:e71–e75CrossRefGoogle Scholar
  3. 3.
    Bae DS, Koo do H, Choi JY, Kim E, Lee KE, Youn YK (2014) Current status of robotic thyroid surgery in South Korea: a web-based survey. World J Surg 38:2632–2639CrossRefGoogle Scholar
  4. 4.
    Paek SH, Kang KH, Park SJ (2018) Expanding indications of robotic thyroidectomy. Surg Endosc 32:3480–3485CrossRefGoogle Scholar
  5. 5.
    Chai YJ, Suh H, Woo JW, Yu HW, Song RY, Kwon H, Lee KE (2017) Surgical safety and oncological completeness of robotic thyroidectomy for thyroid carcinoma larger than 2 cm. Surg Endosc 31:1235–1240CrossRefGoogle Scholar
  6. 6.
    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 148:1214–1221CrossRefGoogle Scholar
  7. 7.
    Yu HW, Chai YJ, Kim SJ, Choi JY, Lee KE (2018) Robotic-assisted modified radical neck dissection using a bilateral axillo-breast approach (robotic BABA MRND) for papillary thyroid carcinoma with lateral lymph node metastasis. Surg Endosc 32:2322–2327CrossRefGoogle Scholar
  8. 8.
    Choi JY, Kang KH (2017) Robotic modified radical neck dissection with bilateral axillo-breast approach. Gland Surg 6:243–249CrossRefGoogle Scholar
  9. 9.
    Seup Kim B, Kang KH, Park SJ (2015) Robotic modified radical neck dissection by bilateral axillary breast approach for papillary thyroid carcinoma with lateral neck metastasis. Head Neck 37:37–45CrossRefGoogle Scholar
  10. 10.
    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 26:3251–3257CrossRefGoogle Scholar
  11. 11.
    Song RY, Sohn HJ, Paek SH, Kang KH (2018) The first report of robotic bilateral modified radical neck dissection through the bilateral axillo-breast approach for papillary thyroid carcinoma with bilateral lateral neck metastasis. Surg Laparosc Endosc Percutaneous Tech. CrossRefGoogle Scholar
  12. 12.
    Paek SH, Kang KH (2016) Robotic thyroidectomy and cervical neck dissection for thyroid cancer. Gland Surg 5:342–351CrossRefGoogle Scholar
  13. 13.
    Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward DL, Tuttle RM, Wartofsky L (2016) 2015 American Thyroid Association Management Guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: The American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid 26:1–133CrossRefGoogle Scholar
  14. 14.
    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 150:1266–1274CrossRefGoogle Scholar
  15. 15.
    Paek SH, Kang KH, Park SJ (2018) A comparison of robotic versus open thyroidectomy for papillary thyroid cancer. Surg Laparosc Endosc Percutaneous Tech 28:170–173Google Scholar
  16. 16.
    Kim MJ, Lee J, Lee SG, Choi JB, Kim TH, Ban EJ, Lee CR, Kang SW, Jeong JJ, Nam KH, Jo YS, Chung WY (2017) Transaxillary robotic modified radical neck dissection: a 5-year assessment of operative and oncologic outcomes. Surg Endosc 31:1599–1606CrossRefGoogle Scholar
  17. 17.
    Austin PC (2011) An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivar Behav Res 46:399–424CrossRefGoogle Scholar
  18. 18.
    Son SK, Kim JH, Bae JS, Lee SH (2015) Surgical safety and oncologic effectiveness in robotic versus conventional open thyroidectomy in thyroid cancer: a systematic review and meta-analysis. Ann Surg Oncol 22:3022–3032CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Se Hyun Paek
    • 1
  • Hye Ah Lee
    • 2
  • Hyungju Kwon
    • 1
  • Kyung Ho Kang
    • 3
    Email author
  • Sung Jun Park
    • 4
  1. 1.Department of Surgery, College of MedicineEwha Womans UniversitySeoulKorea
  2. 2.Clinical Trial CenterEwha Womans University Mokdong HospitalSeoulKorea
  3. 3.New Jahra Hospital Project TeamSeoul National University HospitalSeoulRepublic of Korea
  4. 4.Department of SurgerySung Min HospitalIncheonKorea

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