title: Robotic transaxillary total thyroidectomy through a single axillary incision.
abstract: BACKGROUND
  There is controversy in the literature about whether robotic total thyroidectomy should be performed through unilateral or bilateral axillary incisions. The aim of this study was to perform a detailed critical analysis of the single-incision technique with a focus on postoperative pain, morbidity, and oncologic outcomes.
  
  
  METHODS
  Between June 2009 and May 2012, 30 patients underwent robotic neck surgery through a single axillary incision. The perioperative outcomes of 16 patients who underwent robotic total thyroidectomy were compared with 30 consecutive patients undergoing conventional total thyroidectomy. Data were collected from a prospectively maintained, institutional review board-approved database. All data are presented as mean values ± standard error of the mean.
  
  
  RESULTS
  Both groups were similar regarding age, gender, body mass index, tumor size, and tumor type. For all patients, skin-to-skin operative time (OT) was less in the conventional group (139 ± 8 vs 183 ± 11 minutes, respectively; P = .002). In the robotic group, a significant improvement of the OT occurred after the 6th case: 245 ± 12 minutes for the first 6 cases versus 153 ± 10 minutes for the last 10 cases (P < .001). Estimated blood loss was similar between groups. The median hospital stay was 1 day for both groups. The morbidity was 13% in the conventional and 19% in the robotic group (P = .631).
  
  
  CONCLUSIONS
  Our results show that robotic total thyroidectomy through a single axillary incision is feasible, with similar short-term oncologic results. However, owing to the extent of dissection, the 2-week operative site discomfort is greater after robotic versus conventional total thyroidectomy.
authors.affiliation: Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Shamil
authors.initials: S
authors.lastname: Aliyev
authors.forename: Halit Eren
authors.initials: HE
authors.lastname: Taskin
authors.forename: Orhan
authors.initials: O
authors.lastname: Agcaoglu
authors.forename: Erol
authors.initials: E
authors.lastname: Aksoy
authors.forename: Mira
authors.initials: M
authors.lastname: Milas
authors.forename: Allan
authors.initials: A
authors.lastname: Siperstein
authors.forename: Eren
authors.initials: E
authors.lastname: Berber
mesh_terms: D018263:Adenocarcinoma, Follicular / Q000601:surgery*; D000328:Adult; D001365:Axilla / Q000601:surgery*; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D002277:Carcinoma / Q000601:surgery*; D002291:Carcinoma, Papillary; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010149:Postoperative Pain / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D012371:Robotics / Q000379:methods*; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000601:surgery*; D016606:Thyroid Nodule / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods*; D016896:Treatment Outcome