title: Transaxillary gasless robotic thyroidectomy: a single surgeon's experience in North America.
abstract: OBJECTIVE
  To describe a robotic technique for transaxillary gasless thyroidectomy with the addition of intraoperative peripheral nerve monitoring in the surgical management of thyroid disease.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Academic institution.
  
  
  METHODS
  Fifty patients underwent robotic transaxillary thyroidectomy from September 1, 2009, to August 31, 2010. All the patients underwent preoperative and postoperative direct laryngoscopy. The patients' demographic information, operative times, complications, postoperative hospital stay, and the surgeon's learning curve were evaluated.
  
  
  METHODS
  Feasibility of the robotic approach, patient and gland characteristics, operative time, and complications.
  
  
  RESULTS
  Thirty-nine females and 11 males with a mean age of 48.2 (age range, 13-76) years were included in the study. A total of 37 surgical procedures were lobectomies, and 13 were total or near-total thyroidectomies. The mean nodule size (range) was 24.9 (10-72) mm. The mean operative time (range) was 122.5 (81-280) minutes, mean docking time (range) was 10.1 (6-15) minutes, and mean console time (range) was 55.5 (10-140) minutes. Mean blood loss (range) was 25 (10-100) mL. There were no conversions to conventional open surgery. One patient developed transient radial nerve neuropathy that resolved spontaneously. There were no other postoperative complications. In addition, there was no evidence of vocal cord palsy or paresis on postoperative laryngoscopy. All the patients were discharged home within 24 hours. Subjectively, the cosmetic results were considered excellent owing to the hidden anatomical location of the incision site.
  
  
  CONCLUSIONS
  We have demonstrated the technique to be feasible, safe, and applicable for patients with thyroid disease. We believe that the use of robotic technology for endoscopic thyroid surgical procedures could overcome the limitations of conventional endoscopic surgical procedures in the surgical management of thyroid disease. To our knowledge, this is the first reported large series using this novel technique in the United States.
authors.affiliation: Department of Surgery, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70112, USA. ekandil@tulane.edu
authors.forename: Emad
authors.initials: E
authors.lastname: Kandil
authors.forename: Samy
authors.initials: S
authors.lastname: Abdelghani
authors.forename: Salem I
authors.initials: SI
authors.lastname: Noureldine
authors.forename: Paul
authors.initials: P
authors.lastname: Friedlander
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abdel Khalek
authors.forename: Charles F
authors.initials: CF
authors.lastname: Bellows
authors.forename: Douglas
authors.initials: D
authors.lastname: Slakey
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001365:Axilla / Q000601:surgery*; D002983:Clinical Competence; D005260:Female; D006801:Humans; D007828:Laryngoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D010865:Pilot Projects; D011183:Postoperative Complications; D011446:Prospective Studies; D012371:Robotics; D013959:Thyroid Diseases / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States