Robotic Unilateral Axilo-Breast Approach (R-UABA) Gas-Insufflated Thyroidectomy: Proposal of a Modified Surgical Technique
DOI:
https://doi.org/10.34635/rpc.1121Keywords:
Axilla/surgery, Breast/surgery, Insufflation, Robotic Surgical Procedures, Thyroid Neoplasms/surgery, Thyroidectomy/methodsAbstract
Remote access thyroid surgery demand has increased due to the burden of a visible neck scar. Several surgical techniques have been proposed over the years. We report the surgical modified technique of a robotic unilateral axillo-breast approach (R-UABA) gas-insufflated hemithyroidectomy without hyperextension of the arm. This approach combines the advantages of the use of the robotic platform, to the use of a three port gas-insufflated technique.Downloads
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Durante C, Hegedis L, Czarniecka A, Paschke R, Russ G, Schmitt F, et al. 2023 European Thyroid Association clinical practice guidelines for thyroid nodule management. Eur Thyroid J. 2023;23(2). doi: 10.1530/ETJ-23-0067.
Choi Y, Lee JH, Kim YH, Lee YS, Chang HS, Park CS, Roh MR. Impact of postthyroidectomy scar on the quality of life of thyroid cancer patients. Ann Dermatol. 2014;26:693-9. doi: 10.5021/aad.2014.26.6.693.
Alci E, Kim SY, Yun HJ, Gozener S, Ozdemir M, Turk Y, et al. Evaluation of public’s perception of scar cosmesis after thyroidectomy: results of a survey of Turkish versus South Korean individuals. Ann Surg Res. 2023;105:119-25. doi: 10.4174/astr.2023.105.3.119.
Piccoli M, Mullineris B, Santi D, Gozzo D. Advances in Robotic Transaxillary Thyroidectomy in Europe. Curr Surg Rep. 2017;5:17.
Tae K, Ji YB, Song CM, Ryu J. Robotic and endoscopic thyroid surgery: evolution and advances. Clin Exp Otorhinolaryngol. 2019; 12:1-11. doi: 10.21053/eco.2018.00766.
Yoon JH, Park CH, Chung WY. Gasiess endoscopic thyroidectomy via an axillary approach: experience of 30 cases. Surg Laparosc Endosc Percutan Tech. 2006; 16:226-31. doi: 10.1097/00129689-200608000-00006.
Ikeda Y, Takami H, Sasaki Y, Kan S, Niimi M. Endoscopic neck surgery by the axillary approach. J Am Coll Surg. 2000; 191:336.
Ohgami M, Ishii S, Arisawa Y, Ohmori T, Noga K, Furukawa T, et al. Scarless endoscopic thyroidectomy: breast approach for better cosmesis. Surg Laparosc Endosc Percutan Tech. 2000;10:1-4.
Shimazu K, Shiba E, Tamaki Y, Takiguchi S, Taniguchi E, Ohashi S, et al. Endoscopic thyroid surgery through the axillo-bilateral-breast approach. Surg Laparosc Endosc Percutan Tech. 2003;13:196-201.
Lee MC, Mo JA, Choi LJ, Lee BC, Lee GH. New endoscopic thyroidectomy via a unilateral axillo-breast approach with gas insufflation: preliminary report. Head Neck. 2013;55:471-6. doi: 10.1002/hed.22984.
Vanermen M, Vander Poorten V, Meulemans J. Remote-access robotic thyroidectomy: A systematic review. Int J Med Robot. 2023;19:e25f1. doi: 10.1002/jcs.25f1.
Lee J, Yun JH, Nam KH, Soh EY, Chung WY. The learning curve for robotic thyroidectomy: a multicenter study. Ann Surg Oncol. 2011;1:226-32. doi: 10.1245/s10434-010-1220-z.
Lee J, Nah KY, Kim RM, Ahn YH, Soh EY, Chung WY. Differences in postoperative outcomes, function, and cosmesis: open versus robotic thyroidectomy. Surg Endosc. 2010; 24:3186-94.
Tae K, Ji YB, Jeong JH, Lee SH, Jeong MA, Park CW. 2011. Robotic thyroidectomy by a gasiess unilateral axillo-breast or axillary approach: our early experiences. Surg Endosc. 2011; 25:221-228.
Vidal O, Saavedra-Perez D, Vilaga J, Pantoja JP, Delgado-Oliver E, Lopez-Boado MA, et al. Minimally-invasive endocrine neck surgery. Cir Exp. 2019;97:305-13. doi: 10.1016/j.cirexp.2019.03.010.
Jackson NR, Yao L, Tulano RP, Kandil EH. Safety of robotichyroidectomy approaches: meta-analysis and systematic review. Head Neck. 2024;36:137-43. doi: 10.1002/hed.23223.
Lang BH, Wong CK, Tsang JS, Wong KP, Wan KY. A systematic review and meta-analysis comparing surgically related complications between robotic-assisted thyroidectomy and conventional open thyroidectomy. Ann Surg Oncol. 2014;21:850-61. doi: 10.1245/s10434-013-3406-7.
Piccoli M, Mullineris B, Gozzo D, Colli G, Pecchini F, Nigro C, et al. Evolution Strategies in Transaxillary Robotic Thyroidectomy: Considerations on the First 449 Cases Performed. Front Public Health. 2025;13:1607011. doi: 10.3389/fpubh.2025.1607011.
Lee KE, Kim E, Koo do H, Choi JY, Kim KH, Youn YK. Robotic thyroidectomy by bilateral axillo-breast approach; review of 1,026 cases and surgical completeness. Surg Endosc. 2013; 27:2955-62. doi: 10.1007/s00464-013-2863-1.
Lang BH, Wong CK, Tsang JS, Wong KP, Wan KY. A systematic review and meta-analysis comparing surgically-related complications between robotic-assisted thyroidectomy and conventional open thyroidectomy. Ann Surg Oncol. 2014; 21:850-61. doi: 10.1245/s10434-013-3406-7.
Nguyen HX, Nguyen LT, Nguyen HV, Nguyen HX, Trinh HL, Nguyen TX, et al. Comparison of transoral thyroidectomy vestibular approach and unilateral axillobreast approach forendoscopic thyroidectomy: a prospective cohort study. J Laparocendosc Adv Surg Tech A. 2021;31:11-7. doi: 10.1089/lap.2020.0272.
Saavedra-Perez D, Manyalich M, Dominguez P, Vilaga J, Jordan J, Lopez-Boado MA, Rull R, Vidal O. Thyroidectomy via unilateral axillo-breast approach (UABA) with gas insufflation: prospective multicentre European study. BJS Open. 2022;6:zrac087. doi: 10.1093/bjsopen/zrac087.
Liu SY, Kim JS. Bilateral axillo-breast approach robotic thyroidectomy: review of evidences. Gland Surg. 2017;6:250-7. doi: 10.21037/gs.2017.04.05.
Bellantone R, Lombardi CP, Rubino F, Perilli V, Sollazzi L, Mastroianni G, et al. Arterial PCO2 and cardiovascular function during endoscopic neck surgery with carbon dioxide insufflation. Arch Surg. 2001;156:822-7. doi: 10.1001/archsurg.156.7.822.
Kang SW, Jeong JJ, Yun JS, Sung TY, Lee SC, Lee YS, et al. Gasiess endoscopic thyroidectomy using trans-axillary approach; surgical outcome of 581 patients. Endocr J. 2009;56:361-9. doi: 10.1507/endocj.k08e-306.
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