Overview of robotic thyroidectomy

Abstract

With the advancement and adaptation of technology, there has been a tremendous evolution in the surgical approaches for thyroidectomy. Robotic thyroidectomy has become increasingly popular worldwide attracting both surgeons and patients searching for new and innovative techniques for thyroidectomy with a superior cosmetic result when compared to the conventional open procedures. In this review, we describe the following surgical approaches for robotic thyroidectomy: transaxillary, retroauricular (facelift) and transoral. The advantages and disadvantages as well as limitations of each approach are examined, and future directions of robotic thyroidectomy are discussed.

Keywords: Thyroidectomy; minimally invasive; remote-access; robotic.

Figure 1

Transaxillary robotic thyroidectomy: patient positioning and anatomical landmarks. The ipsilateral arm is extended to expose the axilla. The incision is marked along the posterior edge of the anterior axillary fold; (A) thyroid cartilage, (B) superior border of thyroid lobe, (C) suprasternal notch. The shaded area represents the surface area where the subcutaneous/subplatysmal flap needs to be elevated for working space formation.

Figure 2

Transaxillary robotic thyroidectomy: (A) 3 months postoperative results; (B) the axillary scar is well hidden and not visible when the arm is adducted.

Figure 3

Transaxillary robotic thyroidectomy: docking of the robot for right sided approach. Chung retractor is inserted in the middle of the incision and is secured to expose the working space (arrow). The Maryland dissector (A) and the Harmonic scalpel (C) are placed at the cephalad and caudal extremities of the incision respectively. The 30-degree endoscope (B) is inserted in the middle of the working space inferiorly, sitting right above the pectoralis muscle. The ProGrasp forceps (D) is inserted beneath the Chung retractor: this instrument is inserted off the midline slightly towards the feet of the patient.

Figure 4

Retroauricular robotic thyroidectomy: working space formation. A modified Chung retractor is inserted and secured to expose the working space. Additional retraction is achieved using vicryl sutures to prevent the retroauricular skin flap and the ear lobe from obscuring the working space. SCM, sternocleidomastoid muscle; SSN, suprasternal notch.

Figure 5

Retroauricular robotic thyroidectomy: docking of the robot for the left sided approach. Similar to the transaxillary approach, the Maryland dissector (A) and the Harmonic scalpel (C) are inserted at each extremity of the incision. In the center of the working space, the 30-degree endoscope (D) is inserted. Above the endoscope, the ProGrasp forceps (B) is inserted slightly off the midline towards the feet of the patient.

Figure 6

Transoral robotic thyroidectomy: working space formation. Three incisions are made in the gingival-buccal sulcus: one in the midline (A), approximately 2 cm above the frenulum labii inferioris, and two smaller incisions (B,C) laterally near the angle of mouth.

Figure 7

Transoral robotic thyroidectomy: 1 week postoperatively. There is evidence of suture marks from the vicryl sutures that were applied intraoperatively to retract the subplatysmal flap.