Robotic modified radical neck dissection with bilateral axillo-breast approach.

Bilateral axillo-breast approach (BABA) robotic thyroidectomy has been performed since 2008, and the indications of the BABA robotic operation has been widened to the robotic modified radical neck dissection (MRND). The indication for BABA robotic MRND is suspicious lateral neck metastasis of well-differentiated thyroid carcinoma, and the contraindication is far advanced carcinoma such as encasement of common carotid artery. Surgical procedures start from flap formation as a routine BABA robotic thyroidectomy and the lateral neck dissection is performed from level IV and Vb to level III and IIA. The procedures are very similar to those of open MRND. Comparison between robotic MRND and open MRND in mean age, sex, body mass index, and tumor size were not different significantly. There was no statistically significant difference in the number of retrieved lymph nodes, metastatic lymph nodes or stimulated thyroglobulin level between the groups. The operation time was longer in the robotic group. BABA robotic MRND can be safe and feasible method to treat lateral neck metastasis of well differentiated thyroid carcinoma. More prospective, controlled, multicenter studies are required to establish robotic MRND as an alternative standard and to justify additional costs beyond the cosmetic advantages.