Robotic Thyroidectomy: Is There Still a Role?

  • William S. Duke
  • David J. TerrisEmail author


Thyroidectomy is the most commonly performed endocrine surgery in the world and is regularly accomplished safely with a very low complication profile. Despite the excellent medical outcomes routinely achieved in thyroid surgery, the procedure may result in a cosmetically objectionable anterior neck scar in some patients. In an effort to reduce the cosmetic impact of thyroid surgery, remote access approaches which completely eliminate the risk of a visible neck scar by moving the incision to a more distant, concealed location have been developed and are receiving increasing international attention. These efforts have been facilitated by incorporating the robotic surgical platform into remote access surgery; this has led to the development of the robotic axillary and robotic facelift thyroidectomy (RFT) procedures. While axillary portal approaches, including the bilateral axillo-breast approach (BABA), have been adopted in many Asian markets, they have not been uniformly embraced in Western practices for a number of different reasons. Attempts to reproduce the transaxillary approach in the United States resulted in widespread major complications, including severe blood loss, brachial plexus injury, and tracheal perforation [1–3]. The postauricular (or facelift) approach has emerged as an easier and less invasive alternative for a Western population [4]. Therefore, in appropriately selected patients who are motivated to avoid a visible neck scar, these procedures continue to offer an attractive alternative to anterior cervical thyroidectomy approaches.


Thyroidectomy Thyroid surgery Robotic Remote access Cosmetic 


  1. 1.
    Kuppersmith RB, Holsinger FC. Robotic thyroid surgery: an initial experience with North American patients. Laryngoscope. 2011;121:521–6.CrossRefPubMedGoogle Scholar
  2. 2.
    Landry CS, Grubbs EG, Warneke CL, et al. Robot-assisted transaxillary thyroid surgery in the United States: is it comparable to open thyroid lobectomy? Ann Surg Oncol. 2012;19:1269–74.CrossRefPubMedGoogle Scholar
  3. 3.
    Kandil E, Noureldine S, Yao L, Slakey D. Robotic transaxillary thyroidectomy: an examination of the first one hundred cases. J Am Coll Surg. 2012;214:558–66.CrossRefPubMedGoogle Scholar
  4. 4.
    Terris DJ, Singer MC. Qualitative and quantitative differences between 2 robotic thyroidectomy techniques. Otolaryngol Head Neck Surg. 2012;147(1):20–5.CrossRefPubMedGoogle Scholar
  5. 5.
    Ohgami M, Ishii S, Arisawa Y, et al. Scarless endoscopic thyroidectomy: breast approach for better cosmesis. Surg Laparosc Endosc Percutan Tech. 2000;10:1–4.PubMedGoogle Scholar
  6. 6.
    Ikeda Y, Takami H, Niimi M, et al. Endoscopic thyroidectomy by the axillary approach. Surg Endosc. 2001;15:1362–4.CrossRefPubMedGoogle Scholar
  7. 7.
    Ogden J, Lindridge L. The impact of breast scarring on perceptions of attractiveness. An experimental study. J Health Psychol. 2008;13:303–10.CrossRefPubMedGoogle Scholar
  8. 8.
    Duh QY. Robot-assisted endoscopic thyroidectomy. Has the time come to abandon neck incisions? Ann Surg. 2011;253(6):1067–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Kang SW, Jeong JJ, Yun JS, et al. Gasless endoscopic thyroidectomy using trans-axillary approach; surgical outcomes of 581 patients. Endocr J. 2009;56(3):361–9.CrossRefPubMedGoogle Scholar
  10. 10.
    Kang SW, Jeong JJ, Yun JS, et al. Robot-assisted endoscopic surgery for thyroid cancer: experience with the first 100 patients. Surg Endosc. 2009;23:2399–406.CrossRefPubMedGoogle Scholar
  11. 11.
    Kang SW, Lee SC, Lee SH, et al. Robotic thyroid surgery using a gasless, transaxillary approach and the da Vinci S system: the operative outcomes of 338 consecutive patients. Surgery. 2009;146:1048–55.CrossRefPubMedGoogle Scholar
  12. 12.
    Dionigi G. Robotic thyroid surgery: need for initial stricter patient selection criteria. Surg Laparosc Endosc Percutan Tech. 2009;19(6):518.CrossRefPubMedGoogle Scholar
  13. 13.
    Ryu HR, Kang SW, Lee SH, et al. Feasibility and safety of a new robotic thyroidectomy through a gasless, transaxillary single-incision approach. J Am Coll Surg. 2010;211(3):e13–9.CrossRefPubMedGoogle Scholar
  14. 14.
    Berber E, Siperstein A. Robotic transaxillary total thyroidectomy using a unilateral approach. Surg Laparosc Endosc Percutan Tech. 2011;21:207–10.CrossRefPubMedGoogle Scholar
  15. 15.
    Kang SW, Lee SH, Ryu HR, et al. Initial experience with robot-assisted modified radical neck dissection for the management of thyroid carcinoma with lateral neck node metastasis. Surgery. 2010;148:1214–21.CrossRefPubMedGoogle Scholar
  16. 16.
    Kang SW, Jeong JJ, Nam KH, et al. Robot-assisted endoscopic thyroidectomy for thyroid malignancies using a gasless transaxillary approach. J Am Coll Surg. 2009;209(2):e1–7.CrossRefPubMedGoogle Scholar
  17. 17.
    Seybt M, Kuppersmith RB, Holsinger FC, Terris DJ. Robotic axillary thyroidectomy: multi-institutional clinical experience with the daVinci. Laryngoscope. 2010;120 Suppl 4:S182.CrossRefPubMedGoogle Scholar
  18. 18.
    Perrier N. Why I, have abandoned robot-assisted transaxillary thyroid surgery. Surgery. 2012;152:1025–6.CrossRefPubMedGoogle Scholar
  19. 19.
    Choe JH, Kim SW, Chung KW, et al. Endoscopic thyroidectomy using a new bilateral axillo-breast approach. World J Surg. 2007;31:601–6.CrossRefPubMedGoogle Scholar
  20. 20.
    Kwak HY, Kim HY, Lee HY, et al. Robotic thyroidectomy using bilateral axillo-breast approach: comparison of surgical results with open conventional thyroidectomy. J Surg Oncol. 2015;111:141–5.CrossRefPubMedGoogle Scholar
  21. 21.
    Lee KE, Rao J, Youn YK. Endoscopic thyroidectomy with the da Vinci robot system using the bilateral axillary breast approach (BABA) technique. Our initial experience. Surg Laparosc Endosc Percutan Tech. 2009;19:e71–5.CrossRefPubMedGoogle Scholar
  22. 22.
    Lee KE, Choi JY, Youn YK. Bilateral axillo-breast approach robotic thyroidectomy. Surg Laparosc Endosc Percutan Tech. 2011;21:230–6.CrossRefPubMedGoogle Scholar
  23. 23.
    Singer MC, Seybt MW, Terris DJ. Robot facelift thyroidectomy: I. Preclinical simulation and morphometric assessment. Laryngoscope. 2011;121:1631–5.CrossRefPubMedGoogle Scholar
  24. 24.
    Terris DJ, Singer MC, Seybt MW. Robot facelift thyroidectomy: II. Clinical feasibility and safety. Laryngoscope. 2011;121:1636–41.CrossRefPubMedGoogle Scholar
  25. 25.
    Terris D, Singer MC, Seybt MW. Robotic facelift thyroidectomy: patient selection and technical considerations. Surg Laparosc Endosc Percutan Tech. 2011;21(4):237–42.CrossRefPubMedGoogle Scholar
  26. 26.
    Sosa JA, Bowman HM, Tielsch JM, et al. The importance of surgeon experience for clinical and economic outcomes from thyroidectomy. Ann Surg. 1998;228(3):320–30.PubMedCentralCrossRefPubMedGoogle Scholar
  27. 27.
    Kandil E, Noureldine SI, Abbas A, Tufano RP. The impact of surgical volume on patient outcomes following thyroid surgery. Surgery. 2013;154:1346–53.CrossRefPubMedGoogle Scholar
  28. 28.
    Chung WY. Pros of robotic transaxillary thyroid surgery: its impact on cancer control and surgical quality. Thyroid. 2012;22(10):986–7.CrossRefPubMedGoogle Scholar
  29. 29.
    Lin HS, Folbe AJ, Carron MA, et al. Single-incision transaxillary robotic thyroidectomy: challenges and limitations in a North American population. Otolaryngol Head Neck Surg. 2012;147(6):1041–6.PubMedCentralCrossRefPubMedGoogle Scholar
  30. 30.
    Dionigi G. Robotic thyroidectomy: Seoul is not Varese. Otolaryngol Head Neck Surg. 2013;148:178.CrossRefPubMedGoogle Scholar
  31. 31.
    Li-Tsang CWP, Lau JCM, Chan CCH. Prevalence of hypertrophic scan formation and its characteristics among the Chinese population. Burns. 2005;31:610–6.CrossRefPubMedGoogle Scholar
  32. 32.
    McCurdy JA. Considerations in Asian cosmetic surgery. Facial Plast Surg Clin North Am. 2007;15:387–97.CrossRefPubMedGoogle Scholar
  33. 33.
    Linos D, Kiriakopoulos A, Petralias A. Patient attitudes toward transaxillary robot-assisted thyroidectomy. World J Surg. 2013;37(8):1959–65.CrossRefPubMedGoogle Scholar
  34. 34.
    Coorough NE, Schneider DF, Rosen MW, et al. A survey of preferences regarding surgical approach to thyroid surgery. World J Surg. 2014;38:696–703.PubMedCentralCrossRefPubMedGoogle Scholar
  35. 35.
    Perrier ND, Randolph GW, Inabnet III WB, et al. Robotic thyroidectomy: a framework for new technology assessment and safe implementation. Thyroid. 2010;20(12):1327–32.CrossRefPubMedGoogle Scholar
  36. 36.
    Inabnet WB. Robotic thyroidectomy: must we drive a luxury sedan to arrive at our destination safely? Thyroid. 2012;22:988–90.CrossRefPubMedGoogle Scholar
  37. 37.
    Zarebczan B, McDonald R, Rajamanickam V, et al. Training our future endocrine surgeons: a look at the endocrine surgery operative experience of U.S. surgical residents. Surgery. 2010;148:1075–81.PubMedCentralCrossRefPubMedGoogle Scholar
  38. 38.
    Kang SW, Park JH, Jeong JS, et al. Prospects of robotic thyroidectomy using a gasless transaxillary approach for the management of thyroid carcinoma. Surg Laparosc Endosc Percutan Tech. 2011;21:223–9.CrossRefPubMedGoogle Scholar
  39. 39.
    Jackson NR, Yao L, Tufano RP, Kandil EH. Safety of robotic thyroidectomy approaches: meta-analysis and systematic review. Head Neck. 2014;36(1):137–43.CrossRefPubMedGoogle Scholar
  40. 40.
    Tae K, Ji YB, Cho SH, et al. Early surgical outcomes of robotic thyroidectomy by a gasless unilateral axillo-breast or axillary approach for papillary thyroid carcinoma: 2 years’ experience. Head Neck. 2012;34:617–25.CrossRefPubMedGoogle Scholar
  41. 41.
    Kang SW, Lee SH, Ryu HR, et al. Initial experience with robot-assisted modified radical neck dissection for the management of thyroid carcinoma with lateral neck node metastasis. Surgery. 2010;148:1214–21.CrossRefPubMedGoogle Scholar
  42. 42.
    Cabot JC, Lee CR, Brunaud L, et al. Robotic and endoscopic transaxillary thyroidectomies may be cost prohibitive when compared to standard cervical thyroidectomy: a cost analysis. Surgery. 2012;152:1016–24.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of OtolaryngologyGeorgia Regents UniversityAugustaUSA

Personalised recommendations