Long-term Outcomes of 109 Patients with Papillary Thyroid Carcinoma Who Underwent Robotic Total Thyroidectomy with Central Node Dissection Via the Bilateral Axillo-breast Approach

Background: We developed the bilateral axillo-breast approach (BABA) endoscopic thyroidectomy technique and applied it to the da Vinci robotic surgical system in 2008. Here, the short- and long-term postoperative outcomes of robotic BABA total thyroidectomy with central node dissection (CND) were analyzed. Methods: In 2008-2009, 109 patients with PTC underwent robotic BABA total thyroidectomy with CND. Clinicopathologic characteristics, short- and long-term complications and postoperative thyroglobulin (Tg) level were prospectively obtained and analyzed. Results: The mean age was 39.1 ± 9.5 years and the male to female ratio was 1：5.8. The mean operation time was 206.2 ± 35.8 minutes. Transient recurrent laryngeal nerve (RLN) palsy occurred in 17 cases (15.6%) and transient hypocalcemia in 23 cases (21.1%). The median follow-up was 12 months. There were one (0.9%) and two (1.8%) cases of permanent RLN palsy and permanent hypocalcemia, respectively. Postoperative radioactive iodine (RAI) ablation was performed on 54 patients (49.5%). Their mean stimulated Tg level was 1.84 ± 6.35 ng/mL and 75.9% had stimulated Tg levels below 1.0 ng/mL. Conclusions: Robotic BABA total thyroidectomy with CND yields good postoperative outcomes. Given the excellent cosmetic outcomes, this technique may be a suitable surgical alternative for low-risk patients with PTC.