Trans-axillary Robotic Thyroidectomy and Parathyroidectomy: A Preliminary Single Institution Experience

Objectives: 1) Review our first 13 robotic assisted trans-axillary thyroidectomy and parathyroidectomy (TART/TARP) cases, looking at the clinical and pathological data as well as technical challenges associated with this approach. 2) Examine and discuss complications associated with this approach. Methods: Retrospective series of 13 patients who underwent TART/TARP at our institution. Patient demographics, pathology and size of thyroid glands removed, intraoperative details, length of stay, and postoperative complications were recorded. Results: Over a 14-month period from October 2011 to December 2012, 11 patients (12 female, 1 male) underwent TART, and 2 patients underwent TARP. Mean age was 54 years (range, 29-76 years). All thyroidectomies were partial. Both left-sided parathyroid adenomas had been localized with preoperative imaging to fit criteria for single gland exploration. The largest thyroid lobe removed was 6.5 x 3.5 x 2.8 cm. Pathology was benign thyroid disease in 9 and well differentiated papillary thyroid cancer in 2. Complications included a brachial plexus neuropraxia (n = 1), recurrent laryngeal nerve paresis (n = 1), and inadvertent parathyroid gland removal (n = 1). Both nerve injuries resolved completely in follow up. All patients were discharged within 2 days of surgery, most within 23 hours. Long-term follow up suggest good patient outcomes and patient satisfaction. Conclusions: Robot-assisted trans-axillary thyroidectomy and parathyroidectomy are feasible procedures with good outcomes. Patient selection is key to successful outcome. Surgeons should recognize distant-access related risks including brachial plexus injury and chest paresthesias in addition to conventional thyroidectomy risks and understand how best to diagnose, prevent, and manage these complications.