Robotic thyroid surgery using a gasless transaxillary approach: cosmetic improvement or improved quality of surgical dissection?

In head and neck surgery, minimally invasive approaches have been typically avoided due to concerns about visualization, possible damage to vital structures, and limited availability of effective instrumentation. The incorporation of robotic technology in surgery is now an accepted fact, and because of the complexities of certain laparoscopic procedures, the extended capabilities offered by robotic technology have gained wide acceptance. We report the case of a patient who underwent a robotic total thyroidectomy using a gasless right transaxillary approach. This technique provides a high quality image leading to improved visualization of vital structures during thyroidectomy with the added advantage of avoidance of a neck incision. Several issues regarding this technique remain to be clarified and evaluated in multicenter studies: patient selection, surgeon training and learning curve, postoperative morbidity due to recurrent nerve and parathyroid injury, long term oncologic and cosmetic results. However, we believe that robotic thyroid surgery using a gasless transaxillary approach will advance the frontiers of minimally invasive endocrine surgery.