First Experience of Single-Port Robotic Areolar Approach Thyroidectomy

Abstract

Objectives: Numerous minimally invasive thyroidectomy techniques have been developed and are actively utilized in hospitals around the globe. Herein, we describe a recently developed minimally invasive thyroidectomy technique that employs the da Vinci SP, and we present the preliminary clinical outcomes of single-port robotic areolar thyroidectomy (SPRA).

Methods: A 3-cm semi-circular incision on the right areola and a small 8-mm incision on the left areola were created. Using hydro-dissection and an advanced bipolar device, a subcutaneous skin flap was created, extending from the areola to the thyroid cartilage. The da Vinci SP was then inserted through the incision in the right areola. Between December 2022 and March 2023, 21 SPRA procedures were conducted. Patients' medical records and surgical videos were subsequently reviewed.

Results: Lobectomy was performed in 17 patients, isthmectomy in 2 patients, and total thyroidectomy in 2 patients. The mean flap time was 14.9±4.2 minutes and the console time was 62.4±17.1 minutes. The mean tumor size was 0.89± 0.65 cm and the number of retrieved lymph nodes was 3.94±3.98 (range, 0-12). There were no observed instances of vocal cord palsy or hypoparathyroidism.

Conclusion: We successfully developed and performed the novel SPRA for the first time worldwide. Unlike other robotic surgery.

Methods: SPRA is less invasive and leaves no visible scars. This technique employs a sophisticated single-port robotic device. However, to assess the efficacy of this method, we need to analyze more cases and conduct comparative studies in the near future.

Keywords: Minimally Invasive Surgical Procedures; Robotic Surgical Procedures; Thyroid.

Fig. 1.

Creation of the flap for single-port robotic areolar thyroidectomy (SPRA) and docking of the da Vinci SP. (A) The process of creating the flap for SPRA. (B) The status of port insertion for SPRA. (C) The docking status of the da Vinci SP for SPRA.

Fig. 2.

Procedure for the single-port robotic areolar thyroidectomy operation. (A) The strap muscle's midline and the thyroid isthmus were divided. (B) The thyroid gland was moved to the opposite side, and the area between the thyroid gland and strap muscle was dissected. (C) The thyroid gland was then elevated, and the recurrent laryngeal nerve was identified. (D) The inferior parathyroid gland was preserved, and the thyroid gland was detached from the trachea. (E) The thyroid gland was shifted to the superior pole, and Berry’s ligament was dissected. (F) The superior parathyroid gland was identified and preserved, and a thyroidectomy was performed after the superior thyroid vessels were coagulated. (G) A level 6 central lymph node dissection was performed between the carotid artery and trachea, without impacting the recurrent laryngeal nerve. (H) Both the recurrent laryngeal nerve and the two parathyroid glands were successfully preserved.

Fig. 3.

Postoperative wound after single-port robotic areolar thyroidectomy