title: Factors contributing to surgical outcomes of transaxillary robotic thyroidectomy for papillary thyroid carcinoma.
abstract: BACKGROUND
  Transaxillary robotic thyroidectomy is considered a technically feasible and safe treatment option for patients with low-risk papillary thyroid carcinoma (PTC). The aim of the present study was to determine the factors that contribute to the perioperative surgical outcomes of robotic thyroidectomy and to suggest guidelines for patient selection to be used by surgeons inexperienced in the technique.
  
  
  METHODS
  We reviewed the records of 275 patients with PTC who underwent robotic total thyroidectomy using a gasless, transaxillary single-incision approach at Yonsei University Health System, South Korea, between January 2011 and May 2012. The association between surgical outcomes and clinicopathologic factors was assessed using linear and logistic regression analysis.
  
  
  RESULTS
  The contributing factors for surgical outcomes of robotic thyroidectomy were categorized as patient factors, including gender and body mass index (BMI), and thyroid-specific factors, including thyroid gland size, coexistent thyroiditis, tumor size, and serum anti-thyroglobulin antibody and anti-microsomal antibody titers. Of these, male gender, a large thyroid gland, and thyroiditis significantly increased the total operation time. Male gender, thyroiditis, and overweight BMI increased the working space time, and a large thyroid gland and overweight BMI affected the console time. A large thyroid gland and histological thyroiditis were associated with increased intraoperative blood loss. There was no association between postoperative complications and clinicopathologic parameters.
  
  
  CONCLUSIONS
  Male gender, overweight BMI, a large thyroid gland, and coexistent thyroiditis adversely affected the surgical outcome of robotic thyroidectomy. Surgeons inexperienced in the technique should avoid or carefully approach individuals with these factors.
authors.affiliation: Department of Surgery, International St. Mary's Hospital, Incheon Metropolitan City, Republic of Korea, lakie@ish.or.kr.
authors.forename: Haiyoung
authors.initials: H
authors.lastname: Son
authors.forename: Seulkee
authors.initials: S
authors.lastname: Park
authors.forename: Cho Rok
authors.initials: CR
authors.lastname: Lee
authors.forename: Sohee
authors.initials: S
authors.lastname: Lee
authors.forename: Jung Woo
authors.initials: JW
authors.lastname: Kim
authors.forename: Sang-Wook
authors.initials: SW
authors.lastname: Kang
authors.forename: Jong Ju
authors.initials: JJ
authors.lastname: Jeong
authors.forename: Kee-Hyun
authors.initials: KH
authors.lastname: Nam
authors.forename: Woong Youn
authors.initials: WY
authors.lastname: Chung
authors.forename: Cheong Soo
authors.initials: CS
authors.lastname: Park
mesh_terms: D000293:Adolescent; D000328:Adult; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D015992:Body Mass Index; D002277:Carcinoma / Q000453:epidemiology / Q000601:surgery*; D002291:Carcinoma, Papillary; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D009929:Organ Size; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012371:Robotics / Q000379:methods*; D012737:Sex Factors; D000077273:Thyroid Cancer, Papillary; D013961:Thyroid Gland / Q000473:pathology; D013964:Thyroid Neoplasms / Q000453:epidemiology / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods*; D013966:Thyroiditis / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult