What is the efficacy of robot-assisted thyroidectomy in reducing complications of thyroid surgery?

Updated: Jan 25, 2018
  • Author: Pramod K Sharma, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

Transaxillary thyroidectomy was initially performed with the assistance of endoscopic technology. Robotic technology was then introduced to this approach in 2007. This provided a 3-dimensional field of view with magnification, stabilized visual field, and the potential to use 3 arms under the control of a single surgeon. The robotic technology also provides tremor filtration and fine motion scaling to allow precise manipulation of tissues. Kang et al described a series of 338 patients that underwent a robot-assisted transaxillary thyroidectomy. [17] This report indicated a significant learning curve with approximately 45 robotic procedures before length of surgery stabilized with surgeons that had previously used a transaxillary endoscopic approach. The complication rate was similar to historical open thyroidectomy approach. This approach has introduced new complications not associated with thyroidectomy in the past. Due to the transaxillary approach and the patient armpositioning,brachialplexusinjuries have been reported. Additionally, this procedure typically has a longer operative time and increased blood loss.

This approach has also been used for the treatment of well-differentiated thyroid carcinoma. Transient hypocalcemia has been found to be more frequent in the robotic approach.

The transaxillary robot assisted thyroidectomy approach appears to be replacing endoscopic approaches. The overall experience of alternate approaches to thyroidectomy is in the early stages. Whether any of these approaches will replace the traditional open neck approach to thyroidectomy for benign or malignant disease remains to be seen. Overall complications are similar although the transaxillary approach introduces brachial plexus injuries as potential problems.


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