title: Modified robotic-assisted thyroidectomy: an initial experience with the retroauricular approach.
abstract: OBJECTIVE
  New approaches for robotic-assisted thyroidectomy, including the retroauricular approach, were recently described. We have modified the established surgical approach for retroauricular robotic thyroidectomy. Herein, we report our initial experience to identify challenges and limitations of this new surgical approach.
  
  
  METHODS
  Prospective case series.
  
  
  METHODS
  This study was performed under institutional review board approval for patients who underwent retroauricular robotic hemithyroidectomy at an academic North American institution. The retroauricular approach was modified by using the space between the two heads of the sternocleidomastoid muscle as our working space. Additionally, selected patients underwent concomitant neck lift surgery with robotic thyroid surgery. Clinical characteristics, total operative time, blood loss, surgical outcomes, and length of hospital stay were evaluated.
  
  
  RESULTS
  Twelve female patients were included in this study. Mean age was 45 ± 4.43 years, and mean body mass index was 28.6 ± 2.15. Mean thyroid nodule size was 1.15 ± 0.26 cm(3). All cases were completed successfully via single retroauricular incision. There was no conversion to an open approach. Four out of 12 patients (33%) underwent additional concomitant neck lift surgery, with a mean total operative time of 156 ± 15.88 minutes. The mean operative time for the remaining eight patients who underwent the robotic approach without additional neck lift surgery was 145.4 ± 10.08 minutes. There were no cases of permanent vocal cord paralysis or permanent hypoparathyroidism. Mean blood loss was 22.4 ± 4.32 mL. Four patients (33%) were discharged home on the same day of surgery, and the remaining eight patients were discharged after an overnight stay.
  
  
  CONCLUSIONS
  Single-incision retroauricular robotic hemithyroidectomy can be a safe and feasible alternative to other remote access techniques. Neck lift surgery can be performed safely in a select group of patients. However, future studies are warranted to further evaluate the benefits and limitations of this novel approach.
authors.affiliation: Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A.
authors.forename: Emad
authors.initials: E
authors.lastname: Kandil
authors.forename: Ahmad
authors.initials: A
authors.lastname: Saeed
authors.forename: Salah E
authors.initials: SE
authors.lastname: Mohamed
authors.forename: Nuha
authors.initials: N
authors.lastname: Alsaleh
authors.forename: Rizwan
authors.initials: R
authors.lastname: Aslam
authors.forename: Thomas
authors.initials: T
authors.lastname: Moulthrop
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011446:Prospective Studies; D012371:Robotics / Q000379:methods*; D013961:Thyroid Gland / Q000601:surgery*; D013964:Thyroid Neoplasms / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods*; D016896:Treatment Outcome
keywords: Thyroid surgery; parathyroid; robotic thyroidectomy; thyroid