World Journal of Surgery

, Volume 37, Issue 7, pp 1576–1581 | Cite as

Bilateral Axillo-Breast Approach Robotic Thyroidectomy for Graves’ Disease: An Initial Experience in a Single Institute

  • Hyungju Kwon
  • Do Hoon Koo
  • June Young Choi
  • Eunyoung Kim
  • Kyu Eun LeeEmail author
  • Yeo-Kyu Youn



Bilateral axillo-breast approach (BABA) robotic thyroidectomy has shown excellent cosmetic and surgical outcomes. The aim of the present study was to evaluate the safety, feasibility, and initial outcome of this procedure in patients with Graves’ disease.


From June 2008 to July 2001, a total of 30 patients with Graves’ disease were reviewed retrospectively. Patient demographics, operative indications, and surgical variables, including operative time, blood loss, excised thyroid weight, and complications, were collected and investigated.


The thyroidectomies were classified as total (n = 21), near-total (n = 6), or subtotal (n = 3). There were five indications for surgery: concomitant thyroid carcinoma or suspicious nodule (n = 22), recurrence after antithyroid medication (n = 2), local compressive symptoms (n = 1), patient’s preference (n = 4), and side effects of antithyroid medication (n = 1). The mean operative time, console time, blood loss, and excised thyroid weight were 190 min (range: 105–298 min), 113 min (range: 60–227 min), 229 mL (range: 50–550 mL), and 36.6 g (range: 7.8–123.0 g), respectively. There were no cases of postoperative bleeding or conversions to open surgery. Postoperative transient hypoparathyroidism and vocal cord palsy occurred in 13 (43.3 %) and 4 (13.3 %) cases. Permanent hypoparathyroidism occurred in 1 (3.3 %) case. All patients were satisfied with the cosmetic outcomes.


BABA robotic thyroidectomy is a feasible and safe treatment for Graves’ disease. It is recommended as an alternative for patients who are concerned by the cosmetic effects of traditional thyroidectomy.


Total Thyroidectomy Hypoparathyroidism Vocal Cord Palsy Recurrent Laryngeal Nerve Injury Suspicious Nodule 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Conflict of interest

Drs. Kwon, Koo, Choi, Kim, Lee, and Youn have no conflicts of interest or financial ties to disclose.


  1. 1.
    Sasaki A, Nitta H, Otsuka K et al (2009) Endoscopic subtotal thyroidectomy: the procedure of choice for Graves’ disease? World J Surg 33:67–71. doi: 10.1007/s00268-008-9783-6 PubMedCrossRefGoogle Scholar
  2. 2.
    Bahn Chair RS, Burch HB, Cooper DS et al (2011) Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Thyroid 21:593–646PubMedCrossRefGoogle Scholar
  3. 3.
    Yamamoto M, Sasaki A, Asahi H et al (2001) Endoscopic subtotal thyroidectomy for patients with Graves’ disease. Surg Today 31:1–4PubMedCrossRefGoogle Scholar
  4. 4.
    Berti P, Materazzi G, Galleri D et al (2004) Video-assisted thyroidectomy for Graves’ disease: report of a preliminary experience. Surg Endosc 18:1208–1210PubMedCrossRefGoogle Scholar
  5. 5.
    Maeda S, Uga T, Hayashida N et al (2006) Video-assisted subtotal or near-total thyroidectomy for Graves’ disease. Br J Surg 93:61–66PubMedCrossRefGoogle Scholar
  6. 6.
    Li ZY, Wang P, Wang Y et al (2010) Endoscopic thyroidectomy via breast approach for patients with Graves’ disease. World J Surg 34:2228–2232. doi: 10.1007/s00268-010-0662-6 PubMedCrossRefGoogle Scholar
  7. 7.
    Lee J, Lee JH, Nah KY et al (2011) Comparison of endoscopic and robotic thyroidectomy. Ann Surg Oncol 18:1439–1446PubMedCrossRefGoogle Scholar
  8. 8.
    Choe JH, Kim SW, Chung KW et al (2007) Endoscopic thyroidectomy using a new bilateral axillo-breast approach. World J Surg 31:601–606. doi: 10.1007/s00268-006-0481-y PubMedCrossRefGoogle Scholar
  9. 9.
    Choi JY, Lee KE, Chung KW et al (2012) Endoscopic thyroidectomy via bilateral axillo-breast approach (BABA): review of 512 cases in a single institute. Surg Endosc 26:948–955PubMedCrossRefGoogle Scholar
  10. 10.
    Lee KE, Koo DH, Im HJ et al (2011) Surgical completeness of bilateral axillo-breast approach robotic thyroidectomy: comparison with conventional open thyroidectomy after propensity score matching. Surgery 150:1266–1274PubMedCrossRefGoogle Scholar
  11. 11.
    Lee KE, Choi JY, Youn YK (2011) Bilateral axillo-breast approach robotic thyroidectomy. Surg Laparosc Endosc Percutan Tech 21:230–236PubMedCrossRefGoogle Scholar
  12. 12.
    Huscher CS, Chiodini S, Napolitano C et al (1997) Endoscopic right thyroid lobectomy. Surg Endosc 11:877PubMedCrossRefGoogle Scholar
  13. 13.
    Ohgami M, Ishii S, Arisawa Y et al (2000) Scarless endoscopic thyroidectomy: breast approach for better cosmesis. Surg Laparosc Endosc Percutan Tech 10:1–4PubMedGoogle Scholar
  14. 14.
    Ikeda Y, Takami H, Niimi M et al (2001) Endoscopic thyroidectomy by the axillary approach. Surg Endosc 15:1362–1364PubMedCrossRefGoogle Scholar
  15. 15.
    Shimazu K, Shiba E, Tamaki Y et al (2003) Endoscopic thyroid surgery through the axillo-bilateral-breast approach. Surg Laparosc Endosc Percutan Tech 13:196–201PubMedCrossRefGoogle Scholar
  16. 16.
    Sasaki A, Nakajima J, Ikeda K et al (2008) Endoscopic thyroidectomy by the breast approach: a single institution’s 9-year experience. World J Surg 32:381–385. doi: 10.1007/s00268-007-9375-x PubMedCrossRefGoogle Scholar
  17. 17.
    Kandil E, Noureldine S, Abdel Khalek M et al (2011) Initial experience using robot- assisted transaxillary thyroidectomy for Graves’ disease. J Visc Surg 148:e447–e451PubMedCrossRefGoogle Scholar
  18. 18.
    Youn YK, Oh SK (2011) Surgical treatment for Graves’ disease. In: Oh YC (ed) Surgery of the thyroid and parathyroid glands. SNU Press, Seoul, pp 247–257Google Scholar
  19. 19.
    Witte J, Goretzki PE, Dotzenrath C et al (2000) Surgery for Graves’ disease: total versus subtotal thyroidectomy—results of a prospective randomized trial. World J Surg 24:1303–1311. doi: 10.1007/s002680010216 PubMedCrossRefGoogle Scholar
  20. 20.
    Palit TK, Miller CC 3rd, Miltenburg DM (2000) The efficacy of thyroidectomy for Graves’ disease: a meta-analysis. J Surg Res 90:161–165PubMedCrossRefGoogle Scholar
  21. 21.
    Efremidou EI, Papageorgiou MS, Liratzopoulos N et al (2009) The efficacy and safety of total thyroidectomy in the management of benign thyroid disease: a review of 932 cases. Can J Surg 52:39–44PubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2013

Authors and Affiliations

  • Hyungju Kwon
    • 1
    • 2
    • 3
  • Do Hoon Koo
    • 3
    • 4
  • June Young Choi
    • 1
    • 2
    • 3
  • Eunyoung Kim
    • 1
    • 2
    • 3
  • Kyu Eun Lee
    • 1
    • 2
    • 3
    Email author
  • Yeo-Kyu Youn
    • 1
    • 2
    • 3
  1. 1.Department of SurgerySeoul National University Hospital and College of MedicineSeoulSouth Korea
  2. 2.Division of SurgeryThyroid Center, Seoul National University Cancer HospitalSeoulSouth Korea
  3. 3.Cancer Research InstituteSeoul National University College of MedicineSeoulSouth Korea
  4. 4.Department of Surgery Seoul NationalUniversity Boramae Medical Center and College of MedicineSeoulSouth Korea

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