Surgical Endoscopy

, Volume 31, Issue 4, pp 1599–1606 | Cite as

Transaxillary robotic modified radical neck dissection: a 5-year assessment of operative and oncologic outcomes

  • Min Jhi Kim
  • Jandee Lee
  • Seul Gi Lee
  • Jung Bum Choi
  • Tae Hyung Kim
  • Eun Jeong Ban
  • Cho Rok Lee
  • Sang-Wook Kang
  • Jong Ju Jeong
  • Kee-Hyun Nam
  • Young Suk Jo
  • Woong Youn ChungEmail author



Robotic modified radical neck dissection (MRND) using a gasless transaxillary approach has been reported to be a safe and meticulous technique in patients with papillary thyroid carcinoma (PTC) and lateral neck node metastasis (N1b). Few studies, however, have attempted to assess the long-term oncologic outcomes of robotic MRND in these patients. This study aimed to compare perioperative and 5-year oncologic outcomes of robotic MRND with conventional open procedures in patients with N1b PTC.


Between September 2007 and February 2010, 193 patients with N1b PTC underwent total thyroidectomy and MRND by a single surgeon. Of these, 42 (21.8 %) underwent robotic procedures and 151 (78.2 %) underwent conventional open procedures. All patients received 3.7- to 5.5-GBq radioactive iodine (RAI) ablation, post-therapy whole-body scans (TxWBSs), and diagnostic WBS (DxWBSs) during follow-up. An exact 1:3 matching for age and stage was performed to minimize selection bias, and perioperative and 5-year oncologic outcomes were compared in the matched groups.


The mean follow-up period was 66.0 months (range 60–90 months). Number of retrieved cervical lymph nodes (LNs) (p = .102) and postoperative ablation success rates (p = .864) were similar between the two groups. TSH-suppressed serum Tg concentrations after 5 years (0.7 ± 1.5 vs. 2.4 ± 14.1 ng/ml; p = .471) and recurrence rates in the robotic and open groups (1/41 [2.4 %] vs. 3/102 [2.9 %]; p = .864) were similar for the 5-year follow-up period. Four patients experienced recurrence: Three exhibited regional lymph node metastasis, and one showed bilateral lung metastases.


The perioperative and 5-year oncologic outcomes were similar after robotic and conventional open MRND. Large, prospective randomized controlled trials with long-term follow-up data are needed to validate these results.


Papillary thyroid cancer Lateral neck node metastasis Robotic surgery Modified radical neck dissection Oncologic outcome 



This study was supported by a faculty research grant from Yonsei University College of Medicine for 2015 (6-2015-0056) (to WY Chung) and Intuitive Surgical Clinical Robotics Research Grant (to W.Y. Chung and J. Lee).

Compliance with ethical standards


Min Jhi Kim, Jandee Lee, Seul Gi Lee, Jung Bum Choi, Tae Hyung Kim, Eun Jeong Ban, Cho Rok Lee, Sang-Wook Kang, Jong Ju Jeong, Kee-Hyun Nam, Young Suk Jo, and Woong Youn Chung have no conflicts of interest or financial ties to disclose.


  1. 1.
    Jung KW, Won YJ, Kong HJ, Oh CM, Seo HG, Lee JS (2013) Cancer statistics in Korea: incidence, mortality, survival and prevalence in 2010. Cancer Res Treatm Off J Korean Cancer Assoc 45:1–14Google Scholar
  2. 2.
    Karakoc D, Ozdemir A (2010) Lymph node surgery in papillary thyroid carcinoma. Int Surg 95:142–146PubMedGoogle Scholar
  3. 3.
    Nam IC, Park JO, Joo YH, Cho KJ, Kim MS (2013) Pattern and predictive factors of regional lymph node metastasis in papillary thyroid carcinoma: a prospective study. Head Neck 35:40–45CrossRefPubMedGoogle Scholar
  4. 4.
    Kim YS (2012) Patterns and predictive factors of lateral lymph node metastasis in papillary thyroid microcarcinoma. Otolaryngol Head Neck Surg Off J Am Acad Otolaryngol Head Neck Surg 147:15–19CrossRefGoogle Scholar
  5. 5.
    Lim YS, Lee JC, Lee YS, Lee BJ, Wang SG, Son SM, Kim IJ (2011) Lateral cervical lymph node metastases from papillary thyroid carcinoma: predictive factors of nodal metastasis. Surgery 150:116–121CrossRefPubMedGoogle Scholar
  6. 6.
    Kumar S, Burgess C, Moorthy R (2013) The extent of lateral lymph node dissection in differentiated thyroid cancer in the N + neck. Eur Arch Oto-Rhino-Laryngology Off J Eur Fed Oto-Rhino-Laryngology Soc EUFOS Affil German Soc Oto-Rhino-Laryngology Head Neck Surg 270:2947–2952Google Scholar
  7. 7.
    Caron NR, Clark OH (2005) Papillary thyroid cancer: surgical management of lymph node metastases. Curr Treat Options Oncol 6:311–322CrossRefPubMedGoogle Scholar
  8. 8.
    Zhang ZM, Xu ZG, Li ZJ, An CM, Liu J, Zhu YM, Ni S, Tang PZ (2013) Minimally invasive endoscopy-assisted neck dissection to treat lateral cervical metastasis of thyroid papillary carcinoma. Zhonghua er bi yan hou tou jing wai ke za zhi Chin J Otorhinolaryngol Head Neck Surg 48:712–715Google Scholar
  9. 9.
    Huang XM, Sun W, Hong Y, Cai Q, Liang FY, Han P (2012) Minimally invasive endoscopic thyroidectomy via an anterior chest approach for early papillary thyroid cancer. Zhonghua er bi yan hou tou jing wai ke za zhi Chin J Otorhinolaryngol Head Neck Surg 47:571–574Google Scholar
  10. 10.
    Lombardi CP, Raffaelli M, Princi P, De Crea C, Bellantone R (2007) Minimally invasive video-assisted functional lateral neck dissection for metastatic papillary thyroid carcinoma. Am J Surg 193:114–118CrossRefPubMedGoogle Scholar
  11. 11.
    Moore EJ, Price DL (2011) Robotic surgery for head and neck cancer. Minn Med 94:37–41PubMedGoogle Scholar
  12. 12.
    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 26:3251–3257CrossRefPubMedGoogle Scholar
  13. 13.
    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 148:1214–1221CrossRefPubMedGoogle Scholar
  14. 14.
    Lee J, Kwon IS, Bae EH, Chung WY (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 98:2701–2708CrossRefPubMedGoogle Scholar
  15. 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 214:558–564 (discussion 564–556) CrossRefPubMedGoogle Scholar
  16. 16.
    Cisco RM, Shen WT, Gosnell JE (2012) Extent of surgery for papillary thyroid cancer: preoperative imaging and role of prophylactic and therapeutic neck dissection. Curr Treat Options Oncol 13:1–10CrossRefPubMedGoogle Scholar
  17. 17.
    Kim MJ, Kim EK, Kim BM, Kwak JY, Lee EJ, Park CS, Cheong WY, Nam KH (2009) Thyroglobulin measurement in fine-needle aspirate washouts: the criteria for neck node dissection for patients with thyroid cancer. Clin Endocrinol 70:145–151CrossRefGoogle Scholar
  18. 18.
    Sohn YM, Kim MJ, Kim EK, Kwak JY (2012) Diagnostic performance of thyroglobulin value in indeterminate range in fine needle aspiration washout fluid from lymph nodes of thyroid cancer. Yonsei Med J 53:126–131CrossRefPubMedGoogle Scholar
  19. 19.
    Caron NR, Tan YY, Ogilvie JB, Triponez F, Reiff ES, Kebebew E, Duh QY, Clark OH (2006) Selective modified radical neck dissection for papillary thyroid cancer—Is level I, II and V dissection always necessary? World J Surg 30:833–840CrossRefPubMedGoogle Scholar
  20. 20.
    Lee J, Sung TY, Nam KH, Chung WY, Soh EY, Park CS (2008) Is level IIb lymph node dissection always necessary in N1b papillary thyroid carcinoma patients? World J Surg 32:716–721CrossRefPubMedGoogle Scholar
  21. 21.
    Webb RC, Howard RS, Stojadinovic A, Gaitonde DY, Wallace MK, Ahmed J, Burch HB (2012) The utility of serum thyroglobulin measurement at the time of remnant ablation for predicting disease-free status in patients with differentiated thyroid cancer: a meta-analysis involving 3947 patients. J Clin Endocrinol Metab 97:2754–2763CrossRefPubMedGoogle Scholar
  22. 22.
    Lee S, Lee CR, Lee SC, Park S, Kim HY, Son H, Kang SW, Jeong JJ, Nam KH, Chung WY, Park CS, Cho A (2014) Surgical completeness of robotic thyroidectomy: a prospective comparison with conventional open thyroidectomy in papillary thyroid carcinoma patients. Surg Endosc 28:1068–1075CrossRefPubMedGoogle Scholar
  23. 23.
    Rivere AE, Brooks AJ, Hayek GA, Wang H, Corsetti RL, Fuhrman GM (2014) Parathyroid hormone levels predict posttotal thyroidectomy hypoparathyroidism. Am Surg 80:817–820PubMedGoogle Scholar
  24. 24.
    Kosanke J, Bergstralh E (2004) Match one or more controls to cases using the GREEDY algorithm. Mayo Clinic College of Medicine, Rochester, MNGoogle Scholar
  25. 25.
    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 56:361–369CrossRefPubMedGoogle Scholar
  26. 26.
    Miccoli P, Materazzi G, Berti P (2010) Minimally invasive thyroidectomy in the treatment of well differentiated thyroid cancers: indications and limits. Curr Opin Otolaryngol Head Neck Surg 18:114–118CrossRefPubMedGoogle Scholar
  27. 27.
    Giannopoulos G, Kang SW, Jeong JJ, Nam KH, Chung WY (2013) Robotic thyroidectomy for benign thyroid diseases: a stepwise strategy to the adoption of robotic thyroidectomy (gasless, transaxillary approach). Surg Laparosc Endos Percutaneous Tech 23:312–315CrossRefGoogle Scholar
  28. 28.
    Kang SW, Park JH, Jeong JS, Lee CR, Park S, Lee SH, Jeong JJ, Nam KH, Chung WY, Park CS (2011) Prospects of robotic thyroidectomy using a gasless, transaxillary approach for the management of thyroid carcinoma. Surg Laparosc Endos Percutaneous Tech 21:223–229CrossRefGoogle Scholar
  29. 29.
    Hennessy S, Bilker WB, Berlin JA, Strom BL (1999) Factors influencing the optimal control-to-case ratio in matched case–control studies. Am J Epidemiol 149:195–197CrossRefPubMedGoogle Scholar
  30. 30.
    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 150:1266–1274CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Min Jhi Kim
    • 1
  • Jandee Lee
    • 1
  • Seul Gi Lee
    • 1
  • Jung Bum Choi
    • 1
  • Tae Hyung Kim
    • 1
  • Eun Jeong Ban
    • 1
  • Cho Rok Lee
    • 1
  • Sang-Wook Kang
    • 1
  • Jong Ju Jeong
    • 1
  • Kee-Hyun Nam
    • 1
  • Young Suk Jo
    • 2
  • Woong Youn Chung
    • 1
    Email author
  1. 1.Department of Surgery, Open NBI Convergence Technology Research Laboratory, Severance Hospital, Yonsei Cancer CenterYonsei University College of MedicineSeoulKorea
  2. 2.Department of Internal Medicine, Open NBI Convergence Technology Research Laboratory, Severance Hospital, Yonsei Cancer CenterYonsei University College of MedicineSeoulKorea

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