Comparison Study of Robotic Thyroidectomies Through a Bilateral Axillo-Breast Approach and a Transoral Approach

Introduction: Oncological and surgical safeties are pivotal issues of cancer operations. Robotic thyroidectomy adds cosmetic advantage to those safeties. We have performed bilateral axillo-breast approach robotic thyroidectomies (BABART) since 2009 and recently started transoral robotic thyroidectomy (TORT) in 2017. This study aimed to compare the surgical outcomes of a single surgeon's initial TORT and BABART. Materials and Methods: We retrospectively collected data of 103 patients who underwent robotic thyroid lobectomy for papillary thyroid cancer and analyzed the first 14 and 56 cases of TORT and BABART, respectively, after propensity score matching. The surgeon performed 224 BABARTs before starting TORT. Results: There were no significant differences between the BABART and TORT groups in mean age (40.02 +/- 9.37 versus 38.69 +/- 9.21 years, respectively; P = .7520), sex distribution (P = .3697), mean body mass index (23.60 +/- 4.31 versus 23.87 +/- 2.45 kg/m(2), respectively; P = .4737), and tumor size (0.75 +/- 0.35 versus 0.76 +/- 0.29 cm, respectively; P = .9969). The TORT group had a longer operative time than the BABART group by 78.04 minutes (P < .0001). The visual analog scale pain scores on postoperative day (POD) 2 and POD 3 were higher in the TORT than the BABART group by 0.59 and 0.77, respectively (P = .0227 and .0119, respectively). The number of retrieved lymph nodes and unintended parathyroidectomies was similar in the two groups. There were no severe complications such as tracheal injury, transection of recurrent laryngeal nerve, or surgical site infection. Conclusion: Our study suggests that both BABART and TORT are safe and feasible during the initial period. TORT can be undertaken without any adverse event if the operator is experienced with other robotic thyroidectomy. The patients may choose the surgical approach based on their preference.