title: Bilateral transaxillary endoscopic total thyroidectomy.
abstract: OBJECTIVE
  Minimal-access thyroid surgery using various techniques is well described. The present study reviews our initial experience with total thyroidectomy using a robotic-assisted bilateral transaxillary endoscopic approach (R-BAEA) and a non-robotic-assisted bilateral transaxillary endoscopic approach (BAEA) to assess it's safety and feasibility.
  
  
  METHODS
  The study group was 13 consecutive patients who were candidates for total thyroidectomy with benign thyroid disease. Two young adult patients who were older than 20 years and 2 teenage patients who underwent a transaxillary endoscopic thyroid lobectomy were excluded from this study that was composed of 9 children. A detailed description of the surgical technique is provided.
  
  
  RESULTS
  Eight patients were female and one was male. The mean age was 13.5 +/- 3.0 years. Two R-BAEAs and 7 BAEAs were performed. The initial diagnosis was Graves disease in all 9 cases. The mean operating time was 385 minutes (range, 364-407 minutes) for R-BAEA and 259 minutes (range, 135-385 minutes) for BAEA. The mean diameter of the resected specimens was 5.9 cm (range, 4.5-8.3 cm); the mean intraoperative blood loss was 15.0 mL (range, 10-30 mL). The recurrent laryngeal nerve and parathyroid glands were identified and preserved intact in all cases. No patients required conversion. There was one instance of postoperative wound erythema, and 2 patients experienced hypocalcemia that resolved spontaneously. Two patients with large glands experienced a transient postoperative hoarseness. The mean total postoperative morphine dose administered in the first 24 hours was 1.5 mg (range, 0-4 mg). Postoperative pain was minimal, and cosmetic results were considered excellent by all patients. All except one were discharged the day after surgery and returned immediately to normal activities.
  
  
  CONCLUSIONS
  Total thyroidectomy using BAEA with or without robotic assistance is feasible and safe. The advantages of this approach are no cervical scar, no significant morbidity, less postoperative pain, and early return to normal activity compared with other published techniques.
authors.affiliation: Minimally Invasive Head and Neck Surgery Center, Iowa Methodist Medical Center, Blank Children's Hospital, Des Moines, IA/Iowa State University, Ames, IA 50309, USA. go1993@hotmail.co.jp
authors.forename: Go
authors.initials: G
authors.lastname: Miyano
authors.forename: Thom E
authors.initials: TE
authors.lastname: Lobe
authors.forename: Simon K
authors.initials: SK
authors.lastname: Wright
mesh_terms: D000293:Adolescent; D000328:Adult; D001365:Axilla; D004724:Endoscopy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006111:Graves Disease / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D011446:Prospective Studies; D012016:Reference Values; D018570:Risk Assessment; D012371:Robotics / Q000295:instrumentation*; D012720:Severity of Illness Index; D013960:Thyroid Function Tests; D013965:Thyroidectomy / Q000295:instrumentation* / Q000379:methods; D016896:Treatment Outcome