Introduction/Abstract Objectives: Transcervical incision has been the gold standard for thyroidectomy approach since al-Qasim performed the first goiter removal in 952 AD. However, concern for a a neck scar in certain cultures has motivated the development of remote access techniques, such as the robotic thyroidectomy. Robotic techniques may mitigate cosmetic concerns by providing surgical access through less conspicuous incisions. With this study, we aim to (1) demonstrate the safety and feasibility of the single-port surgical system for retroauricular thyroidectomy and central neck dissection and (2) to review our experience performing the first in-human retroauricular thyroidectomy.
Study Design: Study in Anatomic Laboratory; First in Human Case Report Setting: Academic tertiary care medical centers
Subjects and Methods: The da Vinci Single-port surgical system (Intuitive Surgical, Sunnyvale, CA) was used to perform retroauricular thyroidectomy in four fresh cadavers. Results Through a retroauricular approach, total thyroidectomy and central neck dissections could be performed in all four cadavers. The ideal angle to dock the patient-side cart was at a 90-degree angle to the operating table, with the remote center of the instruments positioned between 10-15cm away from the skin incision site. Greater flexibility and range of motion of the three robotic instruments arms facilitated the procedure by improving efficiency and operation time when compared to the previous robotic systems. Based on the feasibility of these anatomic studies, and approval of the robot for human use in Korea, a retroauricular righ thyroid lobectomy was performed on a 26 year old woman with a 10mm papillary thyroid carcinoma. The single-port system allowed for three instruments to be deployed and successfully. The recurrent laryngeal nerve was identified and preserved, as the right thyroid lobe and isthmus was removed. Using a 0.5 milliAmperes stimulus, an evoked potential of 200 microVolts was elicited. The entire operating time was 90 minutes (10 for docking; 15 for working space elevation; 65 minutes for thyroidectomy).
Conclusion We describe the first preclinical evaluation of the latest and innovative single-port surgical system for retroauricular thyroidectomy and the first successful surgery in human. The use of single-port for robotic retroauricular thyroidectomy was safe, precise, and peformed within the time-frame commonly performed for open surgery.