title: Single-incision transaxillary robotic total thyroidectomy for Graves' disease: improved feasibility and safety with novel robotic instrumentation.
abstract: BACKGROUND
  Graves' disease represents a relative contraindication for robotic thyroidectomy due to increased vascularity with a higher risk of intraoperative bleeding. With a novel robotic instrumentation, however, it is possible to reduce this risk considerably.
  
  
  METHODS
  A 30-year-old female patient with Graves' disease and keloid-prone olive skin underwent a single-incision transaxillary robotic total thyroidectomy through the left axilla using an 8-mm Fenestrated bipolar forceps instead of the standard 8-mm ProGrasp forceps.
  
  
  RESULTS
  Total blood loss was 25 ml, and robotic console time was 132 min. There was no postoperative recurrent palsy. Postoperative parathormone level was 47 ng/l (preop.: 56 ng/l), and serum calcium level was normal at 2,17 mmol/l (preop.: 2,23 mmol/l).
  
  
  CONCLUSIONS
  Transaxillary robotic surgery (TARS) with unilateral single-incision access is feasible and safe for Graves' disease with minimal blood loss and reduced risk of conversion thanks to the bipolar capability of the 8-mm Fenestrated bipolar forceps.
authors.affiliation: Head and Neck Cancer Center, Hubertus Wald University Cancer Center Hamburg, Hamburg, Germany, b.loerincz@uke.de.
authors.forename: Balazs B
authors.initials: BB
authors.lastname: Lörincz
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Möckelmann
authors.forename: Rainald
authors.initials: R
authors.lastname: Knecht
mesh_terms: D000328:Adult; D001365:Axilla; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D006111:Graves Disease / Q000601:surgery*; D006801:Humans; D012371:Robotics / Q000295:instrumentation*; D013965:Thyroidectomy / Q000379:methods*