title: Feasibility and surgical approach of transaxillary robotic thyroidectomy without CO(2) insufflation.
abstract: BACKGROUND
  Our objective was to evaluate the anatomic basis for robotic-assisted transaxillary thyroidectomy and to determine its feasibility in a prospective clinical trial.
  
  
  RESULTS
  Using the da Vinci Surgical Robotic System, we performed 5 cadaveric dissections, via transaxillary approach without gas insufflation. Once the safety and feasibility of this approach had been demonstrated in cadavers, it was utilized to perform a thyroid lobectomy in a patient. The da Vinci system provided excellent visualization of the recurrent and superior laryngeal nerves, parathyroid glands, and paratracheal lymphatics. After the 5 cadaver dissections, the procedure time diminished from >90 minutes to <30 minutes.
  
  
  CONCLUSIONS
  Robotic-assisted transaxillary thyroidectomy is feasible with proper instrumentation and an understanding of the surgical anatomy. Based on this preclinical laboratory study and our experience in 1 patient, further evaluation of this approach in the setting of a prospective clinical trial is warranted to determine standardized criteria identifying patients who would benefit from this approach.
authors.affiliation: Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA.
authors.forename: Carol M
authors.initials: CM
authors.lastname: Lewis
authors.forename: Woong Y
authors.initials: WY
authors.lastname: Chung
authors.forename: F Christopher
authors.initials: FC
authors.lastname: Holsinger
mesh_terms: D001365:Axilla; D002102:Cadaver; D002245:Carbon Dioxide / Q000008:administration & dosage; D002291:Carcinoma, Papillary / Q000601:surgery*; D004210:Dissection; D004867:Equipment Design; D005240:Feasibility Studies; D006801:Humans; D007327:Insufflation / Q000379:methods; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D012371:Robotics / Q000295:instrumentation; D013964:Thyroid Neoplasms / Q000601:surgery*; D013965:Thyroidectomy / Q000295:instrumentation* / Q000379:methods*; D016896:Treatment Outcome; D020535:Video-Assisted Surgery
chemical_list: D002245:Carbon Dioxide