title: New technique using the snake retractor for complete lymph node dissection in robotic thyroid surgery:  initial experiences.
abstract: OBJECTIVE
  We introduce a new technique using a snake retractor to allow for a complete central lymph node dissection (CND) under a more optimal view for robotic thyroid surgery using bilateral axillo-breast approaches.
  
  
  METHODS
  Fifty-eight patients diagnosed with papillary thyroid cancer who underwent robotic thyroidectomy from April to December 2010 were analyzed. A total of 20 patients underwent a robotic surgery without use of snake retractor initially, and 38 patients underwent surgery using snake retractor. Ipsilateral CNDs were performed in all cases.
  
  
  RESULTS
  The number of harvested lymph nodes was 5.3 without use of the snake retractor and 7.9 with use (P = 0.04). Serum thyroglobulins off thyroid hormone in total cases were 0.6 and 0.2, respectively (P = 0.42). The rate of postoperative complications including transient hypocalcemia (n = 8) and transient recurrent laryngeal nerve palsy (n = 2) were low between the 2 groups without a significance.
  
  
  CONCLUSIONS
  Utilization of the snake retractor facilitated safely effective CND with using of 2 arms simultaneously, while providing a superior view to that obtained with robotic thyroid surgery using bilateral axillo-breast approach.
authors: Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Korea. kww1324@naver.com
authors: Wan W
authors: WW
authors: Kim
authors: Jin H
authors: JH
authors: Jung
authors: Ho Y
authors: HY
authors: Park
mesh_terms: D000328:Adult; D002277:Carcinoma / Q000601:surgery*; D002291:Carcinoma, Papillary; D004724:Endoscopy / Q000009:adverse effects / Q000295:instrumentation; D005260:Female; D006801:Humans; D006996:Hypocalcemia / Q000209:etiology; D008197:Lymph Node Excision / Q000009:adverse effects / Q000295:instrumentation*; D008207:Lymphatic Metastasis; D008297:Male; D012371:Robotics / Q000295:instrumentation*; D013525:Surgical Instruments; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000601:surgery*; D013965:Thyroidectomy / Q000295:instrumentation*; D014826:Vocal Cord Paralysis / Q000209:etiology