title: Robotic transaxillary thyroidectomy: an examination of the first one hundred cases.
abstract: BACKGROUND
  The influence of minimally invasive options has led to the application of new evolving techniques in thyroid surgery to eliminate visible neck scars. Here, we describe one author's experience with transaxillary robotic thyroidectomy and examine the effect of experience on determining the learning curve and improvements over time in operative performance.
  
  
  METHODS
  With IRB approval, a prospective analysis of our surgical experience was performed. All patients underwent robotic transaxillary thyroidectomy by a single surgeon between September 2009 and June 2011. Principal outcomes measures included length of hospital stay, incidence of complications, and effect of obesity on outcomes.
  
  
  RESULTS
  One hundred consecutive operations were performed on 91 patients. Sixty-nine hemithyroidectomy, 22 total or near-total thyroidectomy, and 9 completion thyroidectomy procedures were performed. Of patients who underwent hemithyroidectomy, 21.7% were discharged within 4 hours; the remaining patients were discharged within 23 hours. Mean operative time for hemithyroidectomy was 108.1 ± 60.5 minutes, and for total or near-total thyroidectomy, mean operative time was 118.1 ± 51.3 minutes. Mean robot docking time was 9.1 ± 2.2 minutes for all cases. Obesity contributed to prolonged total operative time. Improvement in the length of time to perform components of the procedure was noted after 45 cases. Two cases required conversion to a cervical approach. There were no instances of permanent vocal cord palsy on postoperative laryngoscopy.
  
  
  CONCLUSIONS
  Here we report the largest experience of robotic gasless thyroid surgery in the United States. This novel technique provides excellent cosmetic results and can be performed as an outpatient procedure in selected group of patients. It is feasible and safe, however, has a lengthy learning curve.
authors.affiliation: Department of Surgery, Division of Endocrine and Oncological Surgery, Tulane University School of Medicine, New Orleans, LA 70112, USA. ekandil@tulane.edu
authors.forename: Emad H
authors.initials: EH
authors.lastname: Kandil
authors.forename: Salem I
authors.initials: SI
authors.lastname: Noureldine
authors.forename: Lu
authors.initials: L
authors.lastname: Yao
authors.forename: Douglas P
authors.initials: DP
authors.lastname: Slakey
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001365:Axilla; D015992:Body Mass Index; D002983:Clinical Competence; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D059032:Learning Curve; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012371:Robotics; D013959:Thyroid Diseases / Q000150:complications / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods* / Q000592:standards; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult