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Surgical completeness of robotic thyroidectomy: a prospective comparison with conventional open thyroidectomy in papillary thyroid carcinoma patients

An Erratum to this article was published on 29 April 2015

An Erratum to this article was published on 11 July 2014



Using the da Vinci® robotic system, surgeons can complete secure thyroidectomy without noticeable neck scarring. This study compared the surgical completeness of transaxillary robotic thyroidectomy (RT) with conventional open procedures (OT) in treating papillary thyroid carcinoma (PTC) patients.

Materials and methods

From April 2009 through February 2011, 94 PTC patients underwent total thyroidectomy with central compartment neck dissection (CCND) at Yonsei University College of Medicine. All patients received 1.1 GBq radioactive iodine (RAI) ablation, post-therapy whole-body scans (TxWBS), and diagnostic WBS (DxWBS) 1 year later. We prospectively compared patient clinicopathologic characteristics and surgical completeness between the two groups.


Fifty-one patients underwent OT and 43 underwent RT. Mean age was significantly younger in the RT group. Tumor size, capsular-invasion frequency, multifocality, bilaterality, and central nodal metastasis were not different between the two groups. The number of retrieved nodes during CCND did not significantly differ between the groups. There was no significant difference between the OT and RT groups in stimulated thyroglobulin levels acquired during TxWBS and DxWBS. The RAI uptake ratios at TxWBS were significantly higher in the RT group compared with the OT group; however, follow-up DxWBS showed no difference in RAI uptake ratios. Also, the ablation success rate was similar between the two groups. There were no abnormal findings in follow-up neck ultrasonography in either group.


Remnant thyroid tissue ablation after transaxillary RT was successfully managed by 1.1 GBq RAI. RT showed similar surgical completeness versus conventional OT, and provides a safe and feasible surgical option for PTC patients.

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  1. 1.

    Welbourn RB (1996) Highlights from endocrine surgical history. World J Surg 20(5):603–612

    Article  CAS  PubMed  Google Scholar 

  2. 2.

    Duncan TD, Ejeh IA, Speights F, Rashid QN, Ideis M (2006) Endoscopic transaxillary near total thyroidectomy. JSLS 10(2):206–211

    PubMed Central  PubMed  Google Scholar 

  3. 3.

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

    Article  CAS  PubMed  Google Scholar 

  4. 4.

    Ikeda Y, Takami H, Sasaki Y, Takayama J, Niimi M, Kan S (2002) Comparative study of thyroidectomies: endoscopic surgery versus conventional open surgery. Surg Endosc 16(12):1741–1745

    Article  CAS  PubMed  Google Scholar 

  5. 5.

    Lombardi CP, Raffaelli M, de Crea C, Princi P, Castaldi P, Spaventa A, Salvatori M, Bellantone R (2007) Report on 8 years of experience with video-assisted thyroidectomy for papillary thyroid carcinoma. Surgery 142(6):944–951 discussion 944–951

    Article  PubMed  Google Scholar 

  6. 6.

    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 

  7. 7.

    Miccoli P, Elisei R, Materazzi G, Capezzone M, Galleri D, Pacini F, Berti P, Pinchera A (2002) Minimally invasive video-assisted thyroidectomy for papillary carcinoma: a prospective study of its completeness. Surgery 132(6):1070–1073 discussion 1073–1074

    Article  PubMed  Google Scholar 

  8. 8.

    Shimizu K, Akira S, Jasmi AY, Kitamura Y, Kitagawa W, Akasu H, Tanaka S (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 

  9. 9.

    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 

  10. 10.

    Jeong JJ, Kang SW, Yun JS, Sung TY, Lee SC, Lee YS, Nam KH, Chang HS, Chung WY, Park CS (2009) Comparative study of endoscopic thyroidectomy versus conventional open thyroidectomy in papillary thyroid microcarcinoma (PTMC) patients. J Surg Oncol 100(6):477–480

    Article  PubMed  Google Scholar 

  11. 11.

    Kang SW, Jeong JJ, Yun JS, Sung TY, Lee SC, Lee YS, Nam KH, Chang HS, Chung WY, Park CS (2009) Gasless endoscopic thyroidectomy using trans-axillary approach; surgical outcome of 581 patients. Endocr J 56(3):361–369

    Article  PubMed  Google Scholar 

  12. 12.

    Lee S, Ryu HR, Park JH, Kim KH, Kang SW, Jeong JJ, Nam KH, Chung WY, Park CS (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):1060–1066

    Article  PubMed  Google Scholar 

  13. 13.

    Kang SW, Lee SC, Lee SH, Lee KY, Jeong JJ, Lee YS, Nam KH, Chang HS, Chung WY, Park CS (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 

  14. 14.

    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–e7

    Article  PubMed  Google Scholar 

  15. 15.

    Tae K, Kim KY, Yun BR, Ji YB, Park CW, Kim DS, Kim TW (2012) Functional voice and swallowing outcomes after robotic thyroidectomy by a gasless unilateral axillo-breast approach: comparison with open thyroidectomy. Surg Endosc 26(7):1871–1877

    Article  PubMed  Google Scholar 

  16. 16.

    Tae K, Ji YB, Cho SH, Lee SH, Kim DS, Kim TW (2012) Early surgical outcomes of robotic thyroidectomy by a gasless unilateral axillo-breast or axillary approach for papillary thyroid carcinoma: 2 years’ experience. Head Neck 34(5):617–625

    Article  PubMed  Google Scholar 

  17. 17.

    Lee S, Ryu HR, Park JH, Kim KH, Kang SW, Jeong JJ, Nam KH, Chung WY, Park CS (2012) Early surgical outcomes comparison between robotic and conventional open thyroid surgery for papillary thyroid microcarcinoma. Surgery 151(5):724–730

    Article  PubMed  Google Scholar 

  18. 18.

    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):906–912

    Article  PubMed  Google Scholar 

  19. 19.

    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):3186–3194

    Article  PubMed  Google Scholar 

  20. 20.

    Lee J, Na KY, Kim RM, Oh Y, Lee JH, Lee JS, Kim CH, Soh EY, Chung WY (2012) Postoperative functional voice changes after conventional open or robotic thyroidectomy: a prospective trial. Ann Surg Oncol 19(9):2963–2970

    Article  PubMed  Google Scholar 

  21. 21.

    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 

  22. 22.

    Landry CS, Grubbs EG, Morris GS, Turner NS, Holsinger FC, Lee JE, Perrier ND (2011) Robot assisted transaxillary surgery (RATS) for the removal of thyroid and parathyroid glands. Surgery 149(4):549–555

    Article  PubMed  Google Scholar 

  23. 23.

    Ciabatti PG, Burali G, D’Ascanio L (2012) Single-incision robot-assisted transaxillary surgery for early-stage papillary thyroid cancer. Ann Otol Rhinol Laryngol 121(12):811–815

    Article  PubMed  Google Scholar 

  24. 24.

    Aliyev S, Taskin HE, Agcaoglu O, Aksoy E, Milas M, Siperstein A, Berber E (2013) Robotic transaxillary total thyroidectomy through a single axillary incision. Surgery 153(5):705–710

    Article  PubMed  Google Scholar 

  25. 25.

    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(11):2399–2406

    Article  PubMed  Google Scholar 

  26. 26.

    Ryu HR, Kang SW, Lee SH, Rhee KY, Jeong JJ, Nam KH, Chung WY, Park CS (2010) Feasibility and safety of a new robotic thyroidectomy through a gasless, transaxillary single-incision approach. J Am Coll Surg 211(3):e13–e19

    Article  PubMed  Google Scholar 

  27. 27.

    Lee KE, do Koo 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(6):1266–1274

    Article  PubMed  Google Scholar 

  28. 28.

    Im HJ, do Koo H, Paeng JC, Lee KE, Chung YS, Lim I, Lee DS, Chung JK, Youn YK (2012) Evaluation of surgical completeness in endoscopic thyroidectomy compared with open thyroidectomy with regard to remnant ablation. Clin Nucl Med 37(2):148–151

    Article  PubMed  Google Scholar 

  29. 29.

    Fratkin MJ, Newsome HH Jr, Sharpe AR Jr, Tatum JL (1983) Cervical distribution of iodine 131 following total thyroidectomy for thyroid cancer. Arch Surg 118(7):864–867

    Article  CAS  PubMed  Google Scholar 

  30. 30.

    Leger FA, Izembart M, Dagousset F, Barritault L, Baillet G, Chevalier A, Clerc J (1998) Decreased uptake of therapeutic doses of iodine-131 after 185 MBq iodine-131 diagnostic imaging for thyroid remnants in differentiated thyroid carcinoma. Eur J Nucl Med 25(3):242–246

    Article  CAS  PubMed  Google Scholar 

  31. 31.

    Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, Mazzaferri EL, McIver B, Pacini F, Schlumberger M, Sherman SI, Steward DL, Tuttle RM (2009) Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 19(11):1167–1214

    Article  PubMed  Google Scholar 

  32. 32.

    Lee KE, Kim E, Koo DH, Choi JY, Kim KH, Youn YK (2013) Robotic thyroidectomy by bilateral axillo-breast approach: review of 1026 cases and surgical completeness. Surg Endosc 27(8):2955–2962

    Article  PubMed  Google Scholar 

  33. 33.

    Schlumberger M, Catargi B, Borget I, Deandreis D, Zerdoud S, Bridji B, Bardet S, Leenhardt L, Bastie D, Schvartz C, Vera P, Morel O, Benisvy D, Bournaud C, Bonichon F, Dejax C, Toubert ME, Leboulleux S, Ricard M, Benhamou E (2012) Strategies of radioiodine ablation in patients with low-risk thyroid cancer. N Engl J Med 366(18):1663–1673

    Article  CAS  PubMed  Google Scholar 

  34. 34.

    Mallick U, Harmer C, Yap B, Wadsley J, Clarke S, Moss L, Nicol A, Clark PM, Farnell K, McCready R, Smellie J, Franklyn JA, John R, Nutting CM, Newbold K, Lemon C, Gerrard G, Abdel-Hamid A, Hardman J, Macias E, Roques T, Whitaker S, Vijayan R, Alvarez P, Beare S, Forsyth S, Kadalayil L, Hackshaw A (2012) Ablation with low-dose radioiodine and thyrotropin alfa in thyroid cancer. N Engl J Med 366(18):1674–1685

    Article  CAS  PubMed  Google Scholar 

  35. 35.

    Yi O, Yoon JH, Lee YM, Sung TY, Chung KW, Kim TY, Kim WB, Shong YK, Ryu JS, Hong SJ (2013) Technical and oncologic safety of robotic thyroid surgery. Ann Surg Oncol 20(6):1927–1933

    Article  PubMed  Google Scholar 

  36. 36.

    Cailleux AF, Baudin E, Travagli JP, Ricard M, Schlumberger M (2000) Is diagnostic iodine-131 scanning useful after total thyroid ablation for differentiated thyroid cancer? J Clin Endocrinol Metab 85(1):175–178

    Article  CAS  PubMed  Google Scholar 

  37. 37.

    Pacini F, Capezzone M, Elisei R, Ceccarelli C, Taddei D, Pinchera A (2002) Diagnostic 131-iodine whole-body scan may be avoided in thyroid cancer patients who have undetectable stimulated serum Tg levels after initial treatment. J Clin Endocrinol Metab 87(4):1499–1501

    Article  CAS  PubMed  Google Scholar 

  38. 38.

    Salvatori M, Raffaelli M, Castaldi P, Treglia G, Rufini V, Perotti G, Lombardi CP, Rubello D, Ardito G, Bellantone R (2007) Evaluation of the surgical completeness after total thyroidectomy for differentiated thyroid carcinoma. Eur J Surg Oncol 33(5):648–654

    Article  CAS  PubMed  Google Scholar 

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The authors are grateful to Dong-Su Jang (Medical Illustrator, Medical Research Support Section, Yonsei University College of Medicine, Seoul, Republic of Korea) for his help with the figures.


Drs. Sohee Lee, Cho Rok Lee, Seung Chul Lee, Seulkee Park, Haiyoung Son, Sang-Wook Kang, Jong Ju Jeong, Kee-Hyun Nam, Woong Youn Chung, Cheong Soo Park, Arthur Cho, and Ha Yan Kim have no conflicts of interest or financial ties to disclose.

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Correspondence to Arthur Cho.

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

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  • Robotic thyroidectomy
  • Papillary thyroid carcinoma
  • Surgical completeness