Robot-assisted neck dissection in papillary thyroid carcinoma

Traditionally, total thyroidectomy was performed through an open transcervical incision and in cases where there was evident nodal metastasis, the conventional surgical method was to make an extended single transverse incision or any other long transcervical incisions to complete the required neck dissection. Recently, there have been many efforts towards thyroidectomy in order to decrease the patient’s burden. Minimally invasive surgical techniques have been developed and applied by many institutions worldwide, and more recently, various techniques of remote access surgery have been suggested and actively applied. Since the advent of robotic surgical systems, some have adopted the concept of remote access surgery into developing various robotic thyroidectomy techniques. The more former and widely acknowledged robotic thyroidectomy technique uses a transaxillary (TA) approach which has been developed by Chung et al. in Korea. Terris et al. realized some shortcomings of robotic TA thyroidectomy especially in their patients in the United States and developed and reported the feasibility of robotic facelift thyroidectomy. In cases of thyroid carcinomas with lateral neck node metastases, Chung et al. have attempted to perform concomitant modified radical neck dissection (MRND) after robotic thyroidectomy through the same TA port. This type of robot-assisted neck dissection (RAND), however, had some inherent limitations due to fact that lymph nodes of the upper neck were difficult to remove. Recently, our group devised a modified approach called the transaxillary and retroauricular (TARA) approach, which was shown to be feasible for the upper neck dissection. With the accumulation of experience with the TARA approach, we realized that the retroauricular (RA) or modified facelift (MFL) approach is sufficient for RAND in HNC. Based on our surgical experiences, we could eventually adopt this particular technique to robotic total thyroidectomy and also MRND where needed. However, the long-term outcomes of RAND via TARA or RA approach should be further assessed to determine its oncologic safety.