title: Robotic thyroidectomy: an initial experience with the gasless transaxillary approach.
abstract: BACKGROUND
  Thyroid surgery has recently emerged as one of the most promising fields for the application of robotic surgery. We report the results of the first year of experience with a gasless transaxillary thyroidectomy.
  
  
  METHODS
  From January 2009 to December 2009, 10 consecutive patients (8 women) underwent robotic thyroidectomy through a gasless transaxillary approach. The median age was 44 years (range, 27-42 years). Eight total and two partial thyroidectomies (one left and one right) were performed using the da Vinci(®) Robotic Surgical System (Intuitive Surgical, Sunnyvale, CA). Preoperative diagnosis included solitary nodules with a median size of 16±11 mm (range, 3-44 mm) at preoperative imaging.
  
  
  RESULTS
  All procedures were successfully completed robotically, except one that was converted because of difficulty in achieving an optimal exposure. The overall mean operative time was 177.4±40 minutes (range, 120-240 minutes) with minimal blood loss (<10 mL). Pathological diagnoses included papillary carcinoma (n=6), colloid nodule (n=2), and multinodular goiter (n=2). The mean number of lymph nodes harvested in the cases of malignant disease was 4±5 (range, 3-15). The median postoperative length of stay was 1.05 days (range, 1-1.4 days).
  
  
  CONCLUSIONS
  Thyroid surgery using a gasless transaxillary approach can be performed safely for selected benign and malignant pathology. This approach offers superior cosmetic results and a short hospital stay over conventional thyroid surgery. For selected patients, this technique offers a promising scarless option for minimally invasive thyroid surgery.
authors.affiliation: Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois 60612, USA. piercg@uic.edu
authors.forename: Pier Cristoforo
authors.initials: PC
authors.lastname: Giulianotti
authors.forename: Pietro
authors.initials: P
authors.lastname: Addeo
authors.forename: Nicolas Christian
authors.initials: NC
authors.lastname: Buchs
authors.forename: Subhashini M
authors.initials: SM
authors.lastname: Ayloo
authors.forename: Francesco Maria
authors.initials: FM
authors.lastname: Bianco
mesh_terms: D000328:Adult; D002291:Carcinoma, Papillary / Q000601:surgery; D005260:Female; D006044:Goiter, Nodular / Q000601:surgery; D006801:Humans; D007902:Length of Stay; D008297:Male; D012371:Robotics; D013964:Thyroid Neoplasms / Q000601:surgery; D013965:Thyroidectomy / Q000295:instrumentation / Q000379:methods*