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Yonsei Experience of 5000 Gasless Transaxillary Robotic Thyroidectomies

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Since the use of robot systems in thyroid surgery was introduced in 2007, we have advanced a novel method of robotic thyroidectomy (RT) using a gasless transaxillary approach (TAA). We report our experience with this technique and detail the surgical outcome of 5000 robotic thyroidectomies.


From October 2007 to May 2016, we successfully performed 5000 robotic thyroidectomies using a gasless TAA at the Department of Surgery, Yonsei University Health System. The medical records of the patients are reviewed retrospectively, and the details of clinicopathologic characteristics, operation times, perioperative complications, and oncologic outcomes are analyzed.


The 5000 patients with thyroid tumor (4804 with cancer and 196 with benign tumor) underwent RT using a gasless TAA. Mean operation time was 134.5 ± 122.0 min. The most common histologic subtype of thyroid cancer was papillary (98%), and the mean tumor size was 8.0 ± 6.0 mm. Stage I was found in 85.4% patients regarding tumor nodes metastasis staging. The 196 benign tumors consisted of 104 adenomatous hyperplasias (53.0%), 43 follicular adenomas (21.9%), 30 Graves’ diseases (15.3%), and 19 others (9.7%). Postoperative complication occurred in 24.1% without any serious one, and overall morbidity tended to decrease over time. No disease-specific mortality was observed during the follow-up period. Locoregional recurrence was developed in 26 patients (0.5%).


The authors have tried to improve RT technique using gasless TAA and achieved acceptable surgical outcomes. The rapid evolution of surgical robot technology and our constant effort to advance RT technique using gasless TAA would make it possible to reduce the perioperative morbidity and gain the best possible operative and oncologic outcomes.

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  1. Gagner M (1996) Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism. Br J Surg 83:875

    Article  CAS  PubMed  Google Scholar 

  2. Huscher CS, Chiodini S, Napolitano C et al (1997) Endoscopic right thyroid lobectomy. Surg Endosc 11:877

    Article  CAS  PubMed  Google Scholar 

  3. Shimizu K, Akira S, Jasmi AY et al (1999) Video-assisted neck surgery: endoscopic resection of thyroid tumors with a very minimal neck wound. J Am Coll Surg 188:697–703

    Article  CAS  PubMed  Google Scholar 

  4. Ikeda Y, Takami H, Sasaki Y et al (2000) Endoscopic neck surgery by the axillary approach. J Am Coll Surg 191:336–340

    Article  CAS  PubMed  Google Scholar 

  5. Ohgami M, Ishii S, Arisawa Y et al (2000) Scarless endoscopic thyroidectomy: breast approach for better cosmesis. Surg Laparosc Endosc Percutan Tech 10:1–4

    Article  CAS  PubMed  Google Scholar 

  6. Kang SW, Jeong JJ, Yun JS et al (2009) Gasless endoscopic thyroidectomy using trans-axillary approach; surgical outcome of 581 patients. Endocr J 56:361–369

    Article  PubMed  Google Scholar 

  7. Kang SW, Jeong JJ, Nam KH et al (2009) Robot-assisted endoscopic thyroidectomy for thyroid malignancies using a gasless transaxillary approach. J Am Coll Surg 209:e1–e7

    Article  PubMed  Google Scholar 

  8. Kang SW, Jeong JJ, Yun JS et al (2009) Robot-assisted endoscopic surgery for thyroid cancer: experience with the first 100 patients. Surg Endosc 23:2399–2406

    Article  PubMed  Google Scholar 

  9. Goh HK, Ng YH, Teo DT (2010) Minimally invasive surgery for head and neck cancer. Lancet Oncol 11:281–286

    Article  PubMed  Google Scholar 

  10. Lang BH, Wong CK, Tsang JS et al (2015) A systematic review and meta-analysis evaluating completeness and outcomes of robotic thyroidectomy. Laryngoscope 125:509–518

    Article  PubMed  Google Scholar 

  11. Cooper DS, Doherty GM, Haugen BR et al (2009) Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 19:1167–1214

    Article  PubMed  Google Scholar 

  12. 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:e13–e19

    Article  PubMed  Google Scholar 

  13. 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 148:1214–1221

    Article  PubMed  Google Scholar 

  14. 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 21:223–229

    Article  PubMed  Google Scholar 

  15. Rivere AE, Brooks AJ, Hayek GA et al (2014) Parathyroid hormone levels predict posttotal thyroidectomy hypoparathyroidism. Am Surg 80:817–820

    PubMed  Google Scholar 

  16. Lee S, Lee CR, Lee SC et al (2014) Surgical completeness of robotic thyroidectomy: a prospective comparison with conventional open thyroidectomy in papillary thyroid carcinoma patients. Surg Endosc 28:1068–1075

    Article  PubMed  Google Scholar 

  17. Fuchs KH (2002) Minimally invasive surgery. Endoscopy 34:154–159

    Article  CAS  PubMed  Google Scholar 

  18. Lee J, Chung WY (2013) Robotic surgery for thyroid disease. Eur Thyroid J 2:93–101

    PubMed  PubMed Central  Google Scholar 

  19. 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 Percutan Tech 19:e71–e75

    Article  PubMed  Google Scholar 

  20. Tae K, Song CM, Ji YB et al (2016) Oncologic outcomes of robotic thyroidectomy: 5-year experience with propensity score matching. Surg Endosc 30:4785–4792

    Article  PubMed  Google Scholar 

  21. Cho JN, Park WS, Min SY et al (2016) Surgical outcomes of robotic thyroidectomy vs. conventional open thyroidectomy for papillary thyroid carcinoma. World J Surg Oncol 14:181

    Article  PubMed  PubMed Central  Google Scholar 

  22. Kim MJ, Lee J, Lee SG et al (2017) Transaxillary robotic modified radical neck dissection: a 5-year assessment of operative and oncologic outcomes. Surg Endosc 31:1599–1606

    Article  PubMed  Google Scholar 

  23. Park JH, Lee CR, Park S et al (2013) Initial experience with robotic gasless transaxillary thyroidectomy for the management of graves disease: comparison of conventional open versus robotic thyroidectomy. Surg Laparosc Endosc Percutan Tech 23:e173–e177

    Article  PubMed  Google Scholar 

  24. Kang SW, Lee SH, Park JH et al (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

    Article  PubMed  Google Scholar 

  25. Lee SG, Lee J, Kim MJ et al (2016) Long-term oncologic outcome of robotic versus open total thyroidectomy in PTC: a case-matched retrospective study. Surg Endosc 30:3474–3479

    Article  PubMed  Google Scholar 

  26. Lee J, Kwon IS, Bae EH et al (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

    Article  CAS  PubMed  Google Scholar 

  27. Lee J, Yun JH, Nam KH et al (2011) The learning curve for robotic thyroidectomy: a multicenter study. Ann Surg Oncol 18:226–232

    Article  PubMed  Google Scholar 

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Correspondence to Woong Youn Chung.

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Kim, M.J., Nam, KH., Lee, S.G. et al. Yonsei Experience of 5000 Gasless Transaxillary Robotic Thyroidectomies. World J Surg 42, 393–401 (2018).

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