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February 2011

Are Bilateral Axillary Incisions Needed or Is Just a Single Unilateral Incision Sufficient for Robotic-Assisted Total Thyroidectomy?

Author Affiliations

Author Affiliations: Endocrine and Oncological Surgery Division, Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana.

Arch Surg. 2011;146(2):240-241. doi:10.1001/archsurg.2010.323

It was with great interest that we read the “first” reported case of a robotic-assisted single incision transaxillary completion thyroidectomy performed in the United States and published in the August 2010 issue of Archives by the surgical endocrinology group at M. D. Anderson Cancer Center in Houston, Texas.1

They reported that approaching completion thyroidectomy from the ipsilateral axillary incision would make the dissection challenging because of scarring and difficulty in visualizing the contralateral side. After the publication of this case report,1 a case series reported by Ryu and colleagues2 detailed additional experiences of more than 250 single incision approaches, which help to confirm the validity of this technique. In our own experience, having successfully performed more than 70 such robotic-assisted transaxillary surgical procedures at our institution during the past year, we agree with Landry and colleagues1 that this single incision procedure can be safely performed for thyroid lobectomies and for completion thyroidectomies via separate incision. However, we also believe that total thyroidectomy can be performed safely with this technique with reasonable visualization of the contralateral side. Landry et al1 reported that the operations that were performed on their patient were their fifth and seventh cases of thyroid lobectomy using robotic-assisted transaxillary surgery.