title: Track Recurrence After Robotic Transaxillary Thyroidectomy: A Case Report Highlighting the Importance of Controlled Surgical Indications and Addressing Unprecedented Complications.
abstract: BACKGROUND
  Robot-assisted transaxillary thyroid surgery (RATS), widely accepted and used in Asian countries, can be an appealing treatment option both for patients with major concerns regarding a cervical scar and for their surgeons. Patients benefit from scarless neck surgery, while their surgeons benefit from improved dexterity and ergonomics compared with remote-access endoscopic thyroid surgery. However, validating any novel surgical procedure for thyroid pathology should be based on evidence regarding its feasibility, radicality, and safety compared to the time-honored, safe and effective, conventional open thyroidectomy. It should also be evaluated for potential risks that are not present with conventional approaches.
  
  
  METHODS
  This study reports a patient with surgical track and cervical nodal recurrence, and distant metastasis following a two-stage robot-assisted surgery, and radioactive iodine ablation therapy for a papillary thyroid carcinoma that was initially regarded a single indeterminate nodule.
  
  
  CONCLUSIONS
  This case emphasizes the importance of thoroughly evaluating the oncological safety of RATS, and points out the possibility of "malignant seeding along the surgical access" being an untraditional potential complication associated with the procedure.
  
  
  CONCLUSIONS
  While tailoring the surgical strategy to the patients' concerns and desires is important, adhering to fundamental onco-surgical principles is a priority. Furthermore, unconventional complications associated with novel surgical procedures should be properly evaluated and addressed.
authors: Division of Surgery, Department of Surgical Pathology, University Hospital of Pisa , Pisa, Italy .
authors: Sohail
authors: S
authors: Bakkar
authors: Division of Surgery, Department of Surgical Pathology, University Hospital of Pisa , Pisa, Italy .
authors: Gianluca
authors: G
authors: Frustaci
authors: Division of Surgery, Department of Surgical Pathology, University Hospital of Pisa , Pisa, Italy .
authors: Piermarco
authors: P
authors: Papini
authors: Division of Surgery, Department of Surgical Pathology, University Hospital of Pisa , Pisa, Italy .
authors: Lorenzo
authors: L
authors: Fregoli
authors: Division of Surgery, Department of Surgical Pathology, University Hospital of Pisa , Pisa, Italy .
authors: Valeria
authors: V
authors: Matteucci
authors: Division of Surgery, Department of Surgical Pathology, University Hospital of Pisa , Pisa, Italy .
authors: Gabriele
authors: G
authors: Materazzi
authors: Division of Surgery, Department of Surgical Pathology, University Hospital of Pisa , Pisa, Italy .
authors: Paolo
authors: P
authors: Miccoli
mesh_terms: D000368:Aged; D002277:Carcinoma / Q000000981:diagnostic imaging*; D002291:Carcinoma, Papillary; D004724:Endoscopy / Q000009:adverse effects / Q000379:methods; D004867:Equipment Design; D006801:Humans; D007457:Iodine Radioisotopes / Q000737:chemistry; D008207:Lymphatic Metastasis; D008297:Male; D037981:Neck Dissection / Q000379:methods; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D011183:Postoperative Complications; D065287:Robotic Surgical Procedures / Q000009:adverse effects* / Q000379:methods*; D000077273:Thyroid Cancer, Papillary; D013961:Thyroid Gland / Q000601:surgery; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging*; D013965:Thyroidectomy / Q000009:adverse effects* / Q000379:methods*
chemical_list: D007457:Iodine Radioisotopes