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. 2022 Oct 19;9(2):138-143.
doi: 10.1002/wjo2.83. eCollection 2023 Jun.

Three-port transoral robotic thyroidectomy without axillary incision: A preliminary report of 20 cases in China

Bin Zhang  1 , Bikash Rai  2 , Kuang-Yu Fei  1 , Zong-Hui Han  2 , Michelle Savu  2
Affiliations

Three-port transoral robotic thyroidectomy without axillary incision: A preliminary report of 20 cases in China

Bin Zhang et al. World J Otorhinolaryngol Head Neck Surg. .

Abstract

Objective: Transoral scarless thyroid surgery has proven to be a popular alternative to traditional approaches. Transoral robotic thyroidectomy (TORT) has been reported using ports on the lower lip and axilla. Avoiding axillary incision can further reduce scars on the armpit. Here, we present our preliminary data from the initial 20 consecutive patients to explore the feasibility of three-port TORT without axillary incision.

Methods: From September 2017 to June 2019, we performed TORT at Beijing United Family Hospital using three intraoral ports without axillary incision via the da Vinci Si system with three robotic arms. The outcomes of the procedure were retrospectively reviewed.

Results: Among 20 patients (mean age 30 ± 7 years; mean tumor size 1.64 ± 0.96 cm), 16 patients underwent unilateral thyroid lobectomy and four had total thyroidectomy with or without central neck dissection. Eighteen patients had papillary thyroid carcinomas (PTC), one had a follicular thyroid carcinoma, and one had a thyroid adenoma. The mean surgical time was 221 ± 68 min. The mean number of retrieved central lymph nodes in the PTC patients was 5.6 ± 5. There was no permanent vocal cord palsy or hypocalcemia postoperatively. One patient had transient vocal cord palsy, which resolved within 1 week. Paresthesia of the lower lip and the chin was observed in nine patients, and one patient had a first-degree burn of the skin flap due to the lens.

Conclusion: Three-port TORT without axillary incision is feasible for selected patients and would be a potential alternative for remote-access thyroid surgery to avoid leaving scars on the neck or the armpit.

Keywords: robotic; three port; thyroid carcinoma; thyroidectomy; transoral.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Patient positioned for transoral robotic thyroidectomy. Neck extension was accomplished by using a mat below the shoulder in a lithotomy position.
Figure 2
Figure 2
Three oral incisions of transoral robotic thyroidectomy. One 15 mm incision was made at midline with two lateral incisions 1 cm away on each side.
Figure 3
Figure 3
Trocar placement of transoral robotic thyroidectomy. Three robotic instruments were used through transoral incisions.
Figure 4
Figure 4
Docking of the robot for TORT. Three robotic arms were attached with different trocars through transoral incisions.
Figure 5
Figure 5
Intraoperative photograph of transoral robotic thyroidectomy: the strap muscles were laterally retracted and the pyramid lobe was dissected from the midline.
Figure 6
Figure 6
Intraoperative photograph of transoral robotic thyroidectomy: the superior pedicle of the thyroid was exposed by detaching sternothyroid muscle from thyroid cartilage.
Figure 7
Figure 7
Intraoperative photograph of transoral robotic thyroidectomy: the recurrent laryngeal nerve was identified and cautiously preserved.
See this image and copyright information in PMC

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