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Review
. 2015 Oct;4(5):376-87.
doi: 10.3978/j.issn.2227-684X.2015.05.02.

Remote access thyroid surgery

Parisha Bhatia  1 , Hossam Eldin Mohamed  1 , Abida Kadi  1 , Emad Kandil  1 , Rohan R Walvekar  1
Affiliations
Review

Remote access thyroid surgery

Parisha Bhatia et al. Gland Surg. 2015 Oct.

Abstract

Robot assisted thyroid surgery has been the latest advance in the evolution of thyroid surgery after endoscopy assisted procedures. The advantage of a superior field vision and technical advancements of robotic technology have permitted novel remote access (trans-axillary and retro-auricular) surgical approaches. Interestingly, several remote access surgical ports using robot surgical system and endoscopic technique have been customized to avoid the social stigma of a visible scar. Current literature has displayed their various advantages in terms of post-operative outcomes; however, the associated financial burden and also additional training and expertise necessary hinder its widespread adoption into endocrine surgery practices. These approaches offer excellent cosmesis, with a shorter learning curve and reduce discomfort to surgeons operating ergonomically through a robotic console. This review aims to provide details of various remote access techniques that are being offered for thyroid resection. Though these have been reported to be safe and feasible approaches for thyroid surgery, further evaluation for their efficacy still remains.

Keywords: Robotic-assisted; face-lift thyroidectomy; remote access; retro-auricular; thyroidectomy; trans-axillary.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Patient is positioned supine under general anesthesia and intubated with an NIM endotracheal tube.
Figure 2
Figure 2
Ulnar and median nerves are routinely monitored using Somatosensory evoked potentials (SSEP).
Figure 3
Figure 3
Trans-axillary incision postoperatively.
Figure 4
Figure 4
Landmarks for the robotic trans-axillary incisions.
Figure 5
Figure 5
Subcutaneous plane is developed superficial to the pectoralis major muscle fascia and the heads of the SCM are identified (The plane can be developed using electrocautery or ultrasonic harmonic scalpel).
Figure 6
Figure 6
Retractor used for the trans-axillary approach.
Figure 7
Figure 7
Thyroid is retracted medially using the ProGrasp forceps.
Figure 8
Figure 8
Identification of the recurrent laryngeal nerve (RLN) in the tracheosophageal groove.
Figure 9
Figure 9
Retro-auricular marking posterior to the ear lobe and adjacent to the occipital hairline.
Figure 10
Figure 10
Flap creation superficial to the platysma.
Figure 11
Figure 11
Special retractor placed under sternocleidomastoid (SCM) muscle and the strap muscles to allow continuous exposure to the surgical field.
Figure 12
Figure 12
Da Vinci Si docking using the 30° scope, Maryland dissector and a harmonic scalpel.
See this image and copyright information in PMC

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