Detailed comparison of robotic and endoscopic transaxillary thyroidectomy

Background: Robotic thyroidectomy is increasingly used for patients with papillary thyroid carcinoma (PTC). We compared the differences between robotic and endoscopic transaxillary thyroidectomy with regard to surgical procedures. Methods: This retrospective study enrolled 40 patients with PTC who underwent robotic hemithyroidectomy (robot group) using the Da Vinci S system and 37 patients (endoscopic group) who underwent endoscopic hemithyroidectomy. Video files of surgery for all patients were analyzed to compare the operation procedures: (flap creation, docking [only for robot group], dissection of the superior pole, dissection of the inferior pole, identification of parathyroid glands [PTGs] and the recurrent laryngeal nerve [RLN], dissection of the thyroid along the trachea, bleeding control, application of a drain, and wound closure). The duration of each procedure and the clinicopathological characteristics were analyzed. Results: Procedure time for patients in the robot group was shorter for inferior pole dissection and for identification of the PTGs and RLN (37.5 min vs. 50.5 min, p = 0.008). Mean total operative times for the two groups were comparable (153.0 min vs. 150.2 min, p = 0.732); however, excluding the docking procedure, operation time was shorter for the robot group (133.3 min vs. 150.2 min, p = 0.038). The number of sacrificed PTGs was also significantly smaller in the robot group (0.35 ± 0.53 vs. 0.65 ± 0.68, p = 0.036). Conclusion: Compared to endoscopic thyroidectomy, robotic transaxillary thyroidectomy involved a shorter time for inferior pole dissection and PTGs and RLN identification; moreover, more PTGs were spared using this procedure.