Current Surgery Reports

, 7:20 | Cite as

Robotic-Assisted Modified Radical Neck Dissection: Transaxillary, Bilateral Axill-Breast Approach (BABA), Facelift

  • Kwangsoon Kim
  • Sang-Wook KangEmail author
  • Woong Youn Chung
Robotic Surgery (E. Berber, Section Editor)
Part of the following topical collections:
  1. Robotic Surgery


Purpose of Review

N1b thyroid carcinoma has been surgically treated with open-conventional bilateral total thyroidectomy and modified radical neck dissection (mRND). Recently, the use of robotic method has been increasing for the cosmetic demand of patients. Robotic mRND methods can be divided into transaxillary, bilateral axillo-breast approach (BABA), and facelift depending on how the instruments are inserted.

Recent Findings

About 10 years of experience have been accumulated for transaxillary and BABA, and their oncologic outcomes have also been proven. However, the facelift method requires more experience and oncologic outcome needs to be proven.


Robotic surgery not only reduces the fatigue of the surgeon but also improves the precision of the surgery all the while providing a cosmetic benefit. The advantages and disadvantages of each methods are obvious. The patients will be able to determine the method according to the advantages and disadvantages.


Robot-modified neck dissection Transaxillary Bilateral axillo-breast approach Facelift 


Compliance with Ethics Guidelines

Conflict of interest

Kwangsoon Kim, Sang-Wook Kang, and Woong Youn Chung each declare no potential conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Pellegriti G, Frasca F, Regalbuto C et al. Worldwide increasing incidence of thyroid cancer: update on epidemiology and risk factors. J Cancer Epidemiol 2013.Google Scholar
  2. 2.
    Cramer JD, Fu P, Harth KC, et al. Analysis of the rising incidence of thyroid cancer using the surveillance, epidemiology and end results national cancer data registry. Surgery. 2010;148:1147–53.CrossRefGoogle Scholar
  3. 3.
    Chen AY, Jemal A, Ward EM. Increasing incidence of differentiated thyroid cancer in the United States, 1988–2005. Cancer. 2009;115:3801–7.CrossRefGoogle Scholar
  4. 4.
    Davies L, Welch HG. Increasing incidence of thyroid cancer in the United States, 1973-2002. JAMA. 2006;295:2164–7.CrossRefGoogle Scholar
  5. 5.
    Karakoc D, Ozdemir A. Lymph node surgery in papillary thyroid carcinoma. Int Surg. 2010;95:142–6.PubMedGoogle Scholar
  6. 6.
    Nam IC, Park JO, Joo YH, et al. Pattern and predictive factors of regional lymph node metastasis in papillary thyroid carcinoma: a prospective study. Head Neck. 2013;35:40–5.CrossRefGoogle Scholar
  7. 7.
    Lim Y-S, Lee J-C, Lee YS, et al. Lateral cervical lymph node metastases from papillary thyroid carcinoma: predictive factors of nodal metastasis. Surgery. 2011;150:116–21.CrossRefGoogle Scholar
  8. 8.
    Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016;26:1–133.CrossRefGoogle Scholar
  9. 9.
    Zhang Z, Xu Z, Li Z, et al. Minimally invasive endoscopy-assisted neck dissection to treat lateral cervical metastasis of thyroid papillary carcinoma. Chin J Otorhinolaryngol Head Neck Surg. 2013;48:712–5.Google Scholar
  10. 10.
    Huang X-M, Sun W, Zeng L, et al. Gasless endoscopic thyroidectomy via an anterior chest approach—a review of 219 cases with benign tumor. World J Surg. 2011;35:1281–6.CrossRefGoogle Scholar
  11. 11.
    Kang S-W, Jeong JJ, Yun J-S, et al. Robot-assisted endoscopic surgery for thyroid cancer: experience with the first 100 patients. Surg Endosc. 2009;23:2399.CrossRefGoogle Scholar
  12. 12.
    •• Kang S-W, Lee SH, Park JH et al. 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. 2012;26:3251–3257. This study provides surgical outcomes of transaxillary method compared to open-conventional method. CrossRefGoogle Scholar
  13. 13.
    Yu HW, Chai YJ, Kim S-J et al. Robotic-assisted modified radical neck dissection using a bilateral axillo-breast approach (robotic BABA MRND) for papillary thyroid carcinoma with lateral lymph node metastasis. Surg Endosc. 2018;1–6.Google Scholar
  14. 14.
    •• Byeon HK, Holsinger FC, Tufano RP et al. Robotic total thyroidectomy with modified radical neck dissection via unilateral retroauricular approach. Ann Surg Oncol. 2014;21:3872–3875. This study shows early surgical experience of facelift method. Google Scholar
  15. 15.
    • Kim MJ, Lee J, Lee SG et al. Transaxillary robotic modified radical neck dissection: a 5-year assessment of operative and oncologic outcomes. Surg. Endosc. 2017;31:1599–1606. This study provides 5 year oncologic outcomes of transaxillary method. CrossRefGoogle Scholar
  16. 16.
    •• Kim BS, Kang KH, Park SJ. Robotic modified radical neck dissection by bilateral axillary breast approach for papillary thyroid carcinoma with lateral neck metastasis. Head Neck 2015;37:37–45. This study shows surgical outcomes of BABA method compared to open-conventional method. Google Scholar
  17. 17.
    Park YM, Holsinger FC, Kim WS, et al. Robot-assisted selective neck dissection of levels II to V via a modified facelift or retroauricular approach. Otolaryngol-Head Neck Surg. 2013;148:778–85.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Kwangsoon Kim
    • 1
  • Sang-Wook Kang
    • 1
    Email author
  • Woong Youn Chung
    • 1
  1. 1.Department of SurgeryYonsei University College of MedicineSeoulRepublic of Korea

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