Clin Exp Otorhinolaryngol.  2021 Feb;14(1):137-144. 10.21053/ceo.2020.01585.

Initial Experience With Robotic Modified Radical Neck Dissection Using the da Vinci Xi System Through the Bilateral Axillo-Breast Approach

• Choi YS
• Hong YT
• Yi JW

• KMID: 2512892
• DOI: http://doi.org/10.21053/ceo.2020.01585

Abstract

Objectives
. The bilateral axillo-breast approach (BABA) to robotic thyroidectomy has been extended to modified radical neck dissection (MRND). This study assessed outcomes in patients who underwent robotic MRND through BABA using the da Vinci Xi system.
Methods
. The medical records of 40 patients who underwent total thyroidectomy, bilateral central neck dissection, and MRND from September 2018 to March 2020 were reviewed retrospectively, including 12 who underwent robotic surgery and 28 who underwent open surgery. All operations were performed by a single endocrine surgeon.
Results
. The operation time was significantly longer in the robotic group than in the open group (277.08±32.64 vs. 191.43± 60.43 minutes, respectively, P<0.01), but the number of retrieved lymph nodes did not differ significantly (32.58± 9.31 vs. 34.54±10.90, respectively, P=0.569). The incidence of transient hypoparathyroidism was significantly lower in the robotic group (16.7% [2/12] vs. 53.6% [15/28], P=0.041). The mean hospital stay was shorter (3.92±0.90 vs. 4.71±1.63 days) and the pain score on the first postoperative day was lower (2.92±0.29 vs. 3.18±0.67) in the robotic group. Six of the 12 patients (50%) in the robotic group had stimulated thyroglobulin levels <1.0 ng/mL.
Conclusion
. Robotic MRND through BABA has several advantages, including excellent cosmetic outcomes and a lower incidence of transient hypoparathyroidism than is the case for open MRND. Robotic MRND through BABA may be a promising surgical approach compared with conventional open MRND.

Keyword

Thyroid Neoplasms; Neck Dissection; Robotic Surgical Procedures

Figure

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  Fig. 1. Flap design for robotic modified radical neck dissection (MRND) via bilateral axillo-breast approach (BABA). (A) Schematic blueprint of robotic BABA flap creation. (B) Extended neck flap for MRND. SCM, sternocleidomastoid.

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  Fig. 2. Procedure for robotic modified radical neck dissection using bilateral axillo-breast approach. (A) Division of the omohyoid muscle to expose the internal jugular vein. (B) Level V lymph node dissection, saving the greater auricular and spinal accessory nerves. (C) Pulling of the sternocleidomastoid (SCM) muscle laterally using silk tape. (D) Level IV node dissection, saving the transverse cervical artery. (E) Level III node dissection, saving the phrenic nerve. (F) Level II node dissection around the internal jugular vein.

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  Fig. 3. Comparison of surgical wounds. (A) Scar from open modified radical neck dissection (MRND). (B) No visible neck scar from robotic MRND.

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