Skip to main content
Log in

Safety and Feasibility of Robotic Transaxillary Thyroidectomy for Graves’ Disease: A Retrospective Cohort Study

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

A Correction to this article was published on 26 March 2022

This article has been updated



Despite the increase in experience and understanding of robotic thyroidectomy, its application for Graves’ disease (GD) remains controversial. This study aimed to assess the safety and feasibility of robotic transaxillary thyroidectomy (RTT) for GD in comparison with the conventional open thyroidectomy (open group: OG) approach.


A total of 192 patients who underwent surgical resection for GD were retrospectively reviewed. Among them, 51 patients underwent RTT and the remaining 141 patients were in the conventional OG.


All robotic operations were performed successfully without open conversion. Patients who underwent RTT were significantly younger (P < 0.001) and predominantly of the female sex. Operative time was longer for RTT than for the OG (182.5 ± 58.1 vs. 112.0 ± 29.5; P < 0.001). The mean intraoperative blood loss was not statistically different between RTT and the OG (113.3 ± 161.6 vs. 95.3 ± 209.1, P = 0.223). The mean weight of the resected thyroid was reduced in those who underwent RTT compared with open thyroidectomy (P = 0.033). The overall complication rate for RTT and open thyroidectomy was not significantly different (33.3% vs. 22.7%, P = 0.135). In RTT, the most common complication was transient hypocalcemia (21%). Permanent hypocalcemia and recurrent laryngeal nerve injury occurred in only one patient in each group. The weight of the resected thyroid was not related to the incidence of complications in patients receiving RTT.


Considering excellent cosmesis, findings of this study support the safety and feasibility of RTT. Nevertheless, it should be performed by expert surgeons with extensive robotic surgery experience.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

Change history


  1. Gagner M (1996) Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism. Br J Surg 83(6):875

    Article  CAS  PubMed  Google Scholar 

  2. 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(6):697–703

    Article  CAS  PubMed  Google Scholar 

  3. Miccoli P, Berti P, Raffaelli M, Conte M, Materazzi G, Galleri D (2001) Minimally invasive video-assisted thyroidectomy. Am J Surg 181(6):567–570

    Article  CAS  PubMed  Google Scholar 

  4. Inabnet WB 3rd, Jacob BP, Gagner M (2003) Minimally invasive endoscopic thyroidectomy by a cervical approach. Surg Endosc 17(11):1808–1811

    Article  PubMed  Google Scholar 

  5. Kuppersmith RB, Salem A, Holsinger FC (2009) Advanced approaches for thyroid surgery. Otolaryngol Head Neck Surg 141(3):340–342

    Article  PubMed  Google Scholar 

  6. 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):226–231

    Article  PubMed  Google Scholar 

  7. Miyano G, Lobe TE, Wright SK (2008) Bilateral transaxillary endoscopic total thyroidectomy. J Pediatr Surg 43(2):299–303

    Article  PubMed  Google Scholar 

  8. Ikeda Y, Takami H, Niimi M, Kan S, Sasaki Y, Takayama J (2002) Endoscopic thyroidectomy and parathyroidectomy by the axillary approach. Preliminary Rep Surg Endosc 16(1):92–95

    Article  CAS  Google Scholar 

  9. Sasaki A, Nakajima J, Ikeda K, Otsuka K, Koeda K, Wakabayashi G (2008) Endoscopic thyroidectomy by the breast approach: a single institution’s 9-year experience. World J Surg 32(3):381–385

    Article  PubMed  Google Scholar 

  10. 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):2399–2406

    Article  PubMed  Google Scholar 

  11. 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):1048–1055

    Article  PubMed  Google Scholar 

  12. 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):e1-7

    Article  PubMed  Google Scholar 

  13. Lewis CM, Chung WY, Holsinger FC (2010) Feasibility and surgical approach of transaxillary robotic thyroidectomy without CO(2) insufflation. Head Neck 32(1):121–126

    PubMed  Google Scholar 

  14. Agarwal S, Sabaretnam M, Ritesh A, Chand G (2011) Feasibility and safety of a new robotic thyroidectomy through a gasless, transaxillary single-incision approach. J Am Coll Surg 212(6):1097–1098

    Article  PubMed  Google Scholar 

  15. 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

    Article  PubMed  Google Scholar 

  16. Shen H, Shan C, Qiu M (2014) Systematic review and meta-analysis of transaxillary robotic thyroidectomy versus open thyroidectomy. Surg Laparosc Endosc Percutan Tech 24(3):199–206

    Article  PubMed  Google Scholar 

  17. 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(5):e173-177

    Article  PubMed  Google Scholar 

  18. Noureldine SI, Yao L, Wavekar RR, Mohamed S, Kandil E (2013) Thyroidectomy for Graves’ disease: a feasibility study of the robotic transaxillary approach. ORL J Otorhinolaryngol Relat Spec 75(6):350–356

    Article  PubMed  Google Scholar 

  19. Giddings AE (1998) The history of thyroidectomy. J R Soc Med 91:3–6

    Article  PubMed  PubMed Central  Google Scholar 

  20. Reeve T, Thompson NW (2000) Complications of thyroid surgery: how to avoid them, how to manage them, and observations on their possible effect on the whole patient. World J Surg 24(8):971–975

    Article  CAS  PubMed  Google Scholar 

  21. Huang SM, Liao WT, Lin CF, Sun HS, Chow NH (2016) Effectiveness and Mechanism of Preoperative Lugol Solution for Reducing Thyroid Blood Flow in Patients with Euthyroid Graves’ Disease. World J Surg 40(3):505–509

    Article  PubMed  Google Scholar 

  22. Liu J, Bargren A, Schaefer S, Chen H, Sippel RS (2011) Total thyroidectomy: a safe and effective treatment for Graves’ disease. J Surg Res 168(1):1–4

    Article  PubMed  PubMed Central  Google Scholar 

  23. Palit TK, Miller CC 3rd, Miltenburg DM (2000) The efficacy of thyroidectomy for Graves’ disease: A meta-analysis. J Surg Res 90(2):161–165

    Article  CAS  PubMed  Google Scholar 

  24. Perrier ND (2012) Why I have abandoned robot-assisted transaxillary thyroid surgery. Surgery 152(6):1025–1026

    Article  PubMed  Google Scholar 

  25. Kim MJ, Chung WY (2018) Yonsei Experience of 5000 Gasless Transaxillary Robotic Thyroidectomies: Reply. World J Surg 42(7):2281–2282

    Article  PubMed  Google Scholar 

  26. Schneider DF, Mazeh H, Oltmann SC, Chen H, Sippel RS (2014) Novel thyroidectomy difficulty scale correlates with operative times. World J Surg 38(8):1984–1989

    Article  PubMed  PubMed Central  Google Scholar 

  27. Yamamoto M, Sasaki A, Asahi H et al (2001) Endoscopic subtotal thyroidectomy for patients with Graves’ disease. Surg Today 31(1):1–4

    Article  CAS  PubMed  Google Scholar 

  28. Sasaki A, Nitta H, Otsuka K, Obuchi T, Kurihara H, Wakabayashi G (2009) Endoscopic subtotal thyroidectomy: the procedure of choice for Graves’ disease? World J Surg 33(1):67–71

    Article  PubMed  Google Scholar 

  29. Prete FP, Marzaioli R, Lattarulo S et al (2019) Transaxillary robotic-assisted thyroid surgery: technique and results of a preliminary experience on the Da Vinci Xi platform. BMC Surg 18(Suppl 1):19

    Article  PubMed  PubMed Central  Google Scholar 

  30. Kwon H, Yi JW, Song RY et al (2016) Comparison of Bilateral Axillo-Breast Approach Robotic Thyroidectomy with Open Thyroidectomy for Graves’ Disease. World J Surg 40(3):498–504

    Article  PubMed  Google Scholar 

  31. Garstka M, Kandil E, Saparova L et al (2018) Surgery for Graves’ disease in the era of robotic-assisted surgery: a study of safety and feasibility in the Western population. Langenbecks Arch Surg 403(7):891–896

    Article  PubMed  Google Scholar 

  32. Grodski S, Stalberg P, Robinson BG, Delbridge LW (2007) Surgery versus radioiodine therapy as definitive management for graves’ disease: the role of patient preference. Thyroid 17(2):157–160

    Article  PubMed  Google Scholar 

  33. Boostrom S, Richards ML (2007) Total thyroidectomy is the preferred treatment for patients with Graves’ disease and a thyroid nodule. Otolaryngol Head Neck Surg 136(2):278–281

    Article  PubMed  Google Scholar 

  34. Ku CF, Lo CY, Chan WF, Kung AW, Lam KS (2005) Total thyroidectomy replaces subtotal thyroidectomy as the preferred surgical treatment for Graves’ disease. ANZ J Surg 75(7):528–531

    Article  PubMed  Google Scholar 

Download references


The authors thank the Robot team in our center, especially Ho Young Kim and Hee Chang Yu, for their technical support.


This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Woong Youn Chung.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

The requirement for informed consent was waived owing to the retrospective nature of this study.

Human and animal rights

This study was approved by the Yonsei University institutional review board of our institution (IRB No. 4–2020-1343).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The original online version of this article was revised: Co-authorship note for Mohammed Saad Bu Bshait and Jin Kyong Kim was added.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bu Bshait, M.S., Kim, J.K., Lee, C.R. et al. Safety and Feasibility of Robotic Transaxillary Thyroidectomy for Graves’ Disease: A Retrospective Cohort Study. World J Surg 46, 1107–1113 (2022).

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: