title: Single-incision transaxillary robotic thyroidectomy: challenges and limitations in a North American population.
abstract: OBJECTIVE
  We reviewed our initial experience with robotic thy-roidectomy to identify challenges and limitations of this new surgical approach when applied to a North American population.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Academic institution.
  
  
  METHODS
  Retrospective review of 18 consecutive robotic thyroid lobectomies performed from February 2010 to April 2012 involving 16 female patients. Two patients underwent robot-assisted completion thyroidectomy a few months following the initial thyroid surgery, one for cancer and the other for goiter.
  
  
  RESULTS
  Median age was 47.5 years (range, 18-62 years), and median body mass index was 28.7 (range, 19.4-44.5). Median thyroid nodule size was 2.9 cm (range, 1.1-4.7 cm). All but 1 case (6%) was performed successfully via single axillary incision. There was no conversion to an open approach. Median operative time was 170 minutes (range, 95-220 minutes), and median blood loss was 12.5 mL (range, 5-75 mL). Complications occurred in 4 cases (22%) to include temporary vocal cord pareses (n = 3) and a postoperative hematoma that required exploration. Median hospital stay was 2 days (range, 1-3 days).
  
  
  CONCLUSIONS
  Single-incision transaxillary robotic thyroidectomy can be technically challenging in North American patients with a larger body frame due to difficulty in optimal placement of all 4 robotic instruments via a single axillary incision. All 3 cases of temporary vocal cord paresis occurred early in our experience and may have been due to our relative inexperience with this new approach and associated instrumentation. Other limitations include less than optimal visualization of the recurrent laryngeal nerve in the contralateral lobe as well as poor access to the substernal region.
  
  
  METHODS
  4.
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Wayne State University and Karmanos Cancer Institute, Detroit, MI 48201, USA. hlin@med.wayne.edu
authors.forename: Ho-Sheng
authors.initials: HS
authors.lastname: Lin
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Folbe
authors.forename: Michael A
authors.initials: MA
authors.lastname: Carron
authors.forename: Giancarlo F
authors.initials: GF
authors.lastname: Zuliani
authors.forename: Wei
authors.initials: W
authors.lastname: Chen
authors.forename: George H
authors.initials: GH
authors.lastname: Yoo
authors.forename: Robert H
authors.initials: RH
authors.lastname: Mathog
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001365:Axilla; D015992:Body Mass Index; D005260:Female; D006801:Humans; D008875:Middle Aged; D009656:North America; D061646:Operative Time; D056888:Patient Positioning / Q000379:methods; D012189:Retrospective Studies; D012371:Robotics / Q000295:instrumentation / Q000379:methods*; D013959:Thyroid Diseases / Q000601:surgery; D013965:Thyroidectomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D055815:Young Adult