Transoral robotic-assisted thyroidectomy with central neck dissection: preclinical cadaver feasibility study and proposed surgical technique

Abstract

Recently, a transoral robotic-assisted technique to access the thyroid gland has been introduced. Despite the advantages this approach may have over other minimally invasive and robotic-assisted techniques, we found that the placement of the camera through the floor of mouth led to restricted freedom of movement. We describe our modification to this technique to overcome this problem. In a study using two fresh human cadavers, the camera port of the da Vinci robot was placed in the midline oral vestibule instead of the floor of the mouth. A transoral thyroidectomy and central neck dissection was successfully performed. Our modification led to an unfettered view of the central neck and allowed for a total thyroidectomy and central neck dissection. Our modification of transoral robotic-assisted thyroidectomy provides superior access to the central compartment of the neck over other robotic-assisted thyroidectomy techniques.

Electronic supplementary material: The online version of this article (doi:10.1007/s11701-011-0287-2) contains supplementary material, which is available to authorized users.

Fig. 1

Original approach to the central neck with the endoscopic camera entering through the floor of the mouth. Rotation along the axis of the scope was precluded by the maxillary and mandibular dentition

Fig. 2

Placement of the three ports. Each lateral port was positioned posterior to the mental nerve (MN) and the camera port was placed in the midline between the fasiculus of the mentalis muscle (MM)

Fig. 3

a Docking of the robot. b A view of the flexed neck demonstrating the insufflated working space and no need for external retractors

Fig. 4

Various stages of transoral robotic-assisted thyroidectomy with central neck dissection. a Creation of working cavity with CO₂ insufflation at 8 L/min. b Identification of the superior pole of the right thyroid lobe. c Division of the superior thyroid pedical with the Harmonic scalpel. d Elevation of the right thyroid lobe off the trachea and identification of the recurrent laryngeal nerve. e Division of the isthmus. f Central neck after thyroid lobectomy and lymphadenectomy demonstrating innominate artery, recurrent laryngeal nerve and trachea. TC thyroid cartilage, CTM cricothyroid muscle, RT right thyroid lobe, RLN recurrent laryngeal nerve, T trachea, IA innominate artery

Fig. 5

Post-operative transcervical view of the operative bed demonstrating the area of resection including a right thyroid lobectomy and central neck dissection. RLN recurrent laryngeal nerve, T trachea