title: [Transaxillary robot-assisted thyroidectomy: First experiences with a new operation technique].
abstract: BACKGROUND
  The main advantage of transaxillary robotic-assisted thyroid surgery (TRAT) is the avoidance of a scar on the neck. As TRAT is still rarely performed in Germany, there are not yet any German reports on acceptance, operation times and complications.
  
  
  METHODS
  In a pilot study all patients with an indication for hemithyroidectomy without preoperative evidence of malignancies or previous neck surgery and a lobe size < 30 ml, a body mass index (BMI) < 30 and age > 18 years were offered transaxillary robotic-assisted hemithyroidectomy (TRAHT) after a detailed explanation of this operation. The acceptance of this new technique, the operation time, complications and patient satisfaction were prospectively recorded and analyzed.
  
  
  RESULTS
  Between January 2013 and October 2014 a total of 65 patients were offered the option of a TRAHT and 21 (32%) patients opted for this surgical technique. None of these 21 operations had to be converted and there were no intraoperative complications. The median operation time was 190 min (range 106-300 min) with a significant learning curve (first 5 TRAHT 219 min and last 5 TRAHT 163 min), 10 (48%) patients had a postoperative slight transient skin dysesthesia in the area of the access route, 4 (19%) patients had a transient recurrent laryngeal nerve palsy and 2 patients (9%) had a transient upper brachial plexus palsy. After the first 21 TRAHT operations, 2 Dunhill operations for Grave's disease were also performed via a single axillary incision. The operation times were 320 min and 260 min without complications and 21 out of the 23 patients (91%) were highly satisfied with the cosmetic result and would choose TRAT again.
  
  
  CONCLUSIONS
  The TRAT procedure still has low acceptance by German patients but patient satisfaction after surgery is high due to the cosmetic result. The extended operation time, new complications (e.g. transient plexus palsy) and a potentially increased rate of transient recurrent laryngeal nerve palsy must be critically considered.
authors.affiliation: Klinik für Visceral-, Thorax und Gefäßchirurgie, Philipps-Universität Marburg, Marburg, Deutschland. seckhard@med.uni-marburg.de.|Klinik für Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg Baldingerstraße, 35043, Marburg, Deutschland. seckhard@med.uni-marburg.de.
authors.forename: S
authors.initials: S
authors.lastname: Eckhardt
authors.affiliation: Klinik für Visceral-, Thorax und Gefäßchirurgie, Philipps-Universität Marburg, Marburg, Deutschland.
authors.forename: E
authors.initials: E
authors.lastname: Maurer
authors.affiliation: Klinik für Visceral-, Thorax und Gefäßchirurgie, Philipps-Universität Marburg, Marburg, Deutschland.
authors.forename: V
authors.initials: V
authors.lastname: Fendrich
authors.affiliation: Klinik für Visceral-, Thorax und Gefäßchirurgie, Philipps-Universität Marburg, Marburg, Deutschland.
authors.forename: D K
authors.initials: DK
authors.lastname: Bartsch
mesh_terms: D018263:Adenocarcinoma, Follicular / Q000601:surgery; D000293:Adolescent; D000328:Adult; D001365:Axilla / Q000601:surgery; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010342:Patient Acceptance of Health Care; D017060:Patient Satisfaction; D010865:Pilot Projects; D011183:Postoperative Complications / Q000209:etiology; D012307:Risk Factors; D065287:Robotic Surgical Procedures / Q000379:methods*; D013964:Thyroid Neoplasms / Q000601:surgery; D016606:Thyroid Nodule / Q000601:surgery; D013965:Thyroidectomy / Q000379:methods*; D055815:Young Adult
keywords: Acceptance; Hemithyroidectomy; Learning curve; Robotic assisted thyroidectomy; Transaxillary robotic surgery