Robot assisted transaxillary surgery (RATS) for the removal of thyroid and parathyroid glands.
BACKGROUND
Robotic assisted transaxillary surgery (RATS) is a minimally invasive approach for the removal of the thyroid and/or parathyroid glands through the axilla. This anatomically directed technique, popularized by Chung, eliminates a visible scar and affords excellent high definition optics of the cervical anatomy. We report an initial series of single access RATS in the U.S.


METHODS
The prospective endocrine surgery database at a tertiary care center was used to capture all patients who underwent RATS between October 2009 and March 2010. All procedures were performed using a single transaxillary incision.


RESULTS
Fourteen operations were performed on 13 patients. Indications for RATS were indeterminate thyroid nodules in 11 patients, the need for completion thyroidectomy in 1 patient, and primary hyperparathyroidism in 2 patients. For patients who underwent robotic assisted thyroid lobectomy, the median thyroid nodule size was 2.1 cm (range, 0.8-2.8 cm), and the median body mass index was 25.33 (range, 21.3-34.4). Mean and median total operative times for robotic assisted thyroid lobectomies were 142 minutes and 137 minutes respectively (range, 113-192 minutes). Operative time for the 2 patients who underwent robotic assisted parathyroidectomy was 115 and 102 minutes. Minor complications occurred in 4 patients (28.5%), with no significant perioperative morbidity or mortality.


CONCLUSIONS
RATS is feasible. We believe that further study of the RATS technique for removing thyroid lobes and parathyroid glands is warranted. This initial series suggests that careful, continued investigation is necessary prior to routine implementation into clinical practice across the U.S.
Department of Surgical Oncology, Section of Surgical Endocrinology, University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA. nperrier@mdanderson.org
Christine S
CS
Landry
Elizabeth G
EG
Grubbs
G Stephen
GS
Morris
Nadine S
NS
Turner
F Christopher
FC
Holsinger
Jeffrey E
JE
Lee
Nancy D
ND
Perrier
D000328:Adult; D001365:Axilla / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D010280:Parathyroid Glands / Q000601:surgery*; D012371:Robotics; D013961:Thyroid Gland / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods*