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 "excerpt": "Robotic thyroidectomy is a surgical technique that removes all or part of the thyroid through incisions in the axilla, breast, or behind the ear, avoiding a neck scar.",
 "snippet": "Robotic thyroidectomy is a surgical technique that removes all or part of the thyroid through incisions in the axilla, breast, or behind the ear, avoiding a neck scar.",
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 "markdown": "# Robotic thyroidectomy\n\n## Robotic thyroidectomy\n\nRobotic thyroidectomy is a surgical technique that removes all or part of the thyroid gland through incisions placed away from the neck, such as in the axilla, breast, or behind the ear, using robotic-assisted instruments rather than direct manual instrumentation. It was developed to avoid a cervical scar while offering the instrument articulation and visualization of endoscopic surgery, and it is performed for benign nodules, Graves disease, and selected differentiated thyroid cancers.\n\n| Key fact | Detail |\n|---|---|\n| Approaches | Transaxillary, bilateral axillo-breast (BABA), retroauricular/facelift, and transoral (TORT) routes have all been applied in patients<sup>[1](https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2023.1196021/full)</sup> |\n| Common stages | Working space formation, docking, and console stages, regardless of approach<sup>[2](https://gs.amegroups.org/article/view/14633/html)</sup> |\n| Operative time | 43.5 minutes longer than the conventional cervical approach in one meta-analysis of 4878 patients<sup>[3](https://journals.sagepub.com/doi/10.1177/1553350615613451)</sup>; 76.7 minutes longer in another review of 12 studies<sup>[4](https://aao-hnsfjournals.onlinelibrary.wiley.com/doi/10.1177/0194599814521779)</sup> |\n| Complications | No significant differences versus conventional thyroidectomy in hematoma, seroma, recurrent laryngeal nerve (RLN) injury, hypocalcemia, or chyle leak rates<sup>[4](https://aao-hnsfjournals.onlinelibrary.wiley.com/doi/10.1177/0194599814521779)</sup> |\n| Cost | Transaxillary robotic thyroidectomy cost $13,670 versus $9,028 for conventional open surgery in one reported comparison<sup>[2](https://gs.amegroups.org/article/view/14633/html)</sup> |\n| Learning curve | 35–50 cases for the transaxillary approach and about 40 cases for BABA<sup>[5](https://synapse.koreamed.org/articles/1157736)</sup> |\n| Single-port platform | The da Vinci SP passes three instruments and a stereoscopic camera through a single 28 mm outer diameter cannula<sup>[1](https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2023.1196021/full)</sup> |\n\n### How it works\n\nThe da Vinci system ([Intuitive Surgical](https://www.edgepedia.org/intuitive-surgical)) gives the surgeon high-definition three-dimensional imaging, wristed EndoWrist instruments with freedom of motion beyond what straight laparoscopic tools allow, and [tremor filtering](https://www.edgepedia.org/tremor-filtering). These advantages are weighed against high cost, longer operative times, and the absence of tactile sensation.<sup>[6](https://www.intechopen.com/chapters/55664)</sup> Because the thyroid sits deep in the neck, the robot cannot simply be inserted through a small neck incision; instead, the surgeon creates a subplatysmal (beneath the platysma, a thin neck muscle) working space reaching from a remote incision to the thyroid, holds it open with a retractor (gasless technique) or with low-pressure carbon dioxide insufflation, and operates with long instruments passed under the flap.<sup>[6](https://www.intechopen.com/chapters/55664)</sup>\n\nThe single-port da Vinci SP integrates a flexible, fully wristed three-dimensional endoscope with three multi-jointed instruments in one 2.5-cm cannula, reducing external arm collisions and allowing a smaller, concealed incision with less flap dissection.<sup>[7](https://pmc.ncbi.nlm.nih.gov/articles/PMC12799353/)</sup>\n\n### How it is done\n\nEvery robotic thyroidectomy follows three consistent stages: working space formation, docking, and the console stage.<sup>[2](https://gs.amegroups.org/article/view/14633/html)</sup>\n\nIn the transaxillary approach, the patient lies supine with slight neck extension from a shoulder roll or thyroid pillow, and the ipsilateral arm is extended and rotated toward the head; over-extension is avoided to prevent brachial plexus injury. A 5–6 cm curved-vertical incision is marked just posterior to the anterior axillary fold.<sup>[2](https://gs.amegroups.org/article/view/14633/html)</sup> During docking in a transaxillary case, a 30° stereoscopic endoscope is docked first, in the middle of the incision, with the camera directed 20°–30° upward with respect to the floor and 10°–20° toward the patient's feet.<sup>[8](https://ricerca.uniba.it/retrieve/dd9e0c65-b846-1e9c-e053-3a05fe0a45ef/transaxillary%20robotic-assisted.pdf)</sup>\n\nIn BABA, a standardized four-port configuration is used: two 8-mm axillary ports and two 12-mm periareolar ports, on the da Vinci system.<sup>[6](https://www.intechopen.com/chapters/55664)</sup> The 12-mm camera port goes through the right breast incision and an 8-mm port for the Harmonic ultrasonic shear through the left; the workspace is maintained at low pressure (5–6 mmHg) CO₂ through the camera port.<sup>[6](https://www.intechopen.com/chapters/55664)</sup> The subcutaneous flap is dissected bluntly to the cricoid cartilage with a vascular tunneler, keeping the plane above the breast parenchyma and avoiding excessive force near the sternal notch.<sup>[6](https://www.intechopen.com/chapters/55664)</sup>\n\n### Origin\n\nRemote-access thyroid surgery began as an endoscopic technique. Endoscopic methods used either continuous CO₂ insufflation to create the working space or a gasless technique with the scar hidden in the axilla, where the arm covers it in its natural position.<sup>[9](https://www.jstage.jst.go.jp/article/endocrj/56/3/56_K08E-306/_pdf)</sup> Robotic systems were then applied to these established remote-access routes.\n\nThe earliest large robotic series came from South Korea. From October 2007 to November 2008, 338 patients underwent robot-assisted endoscopic thyroid operations using a gasless transaxillary approach with the da Vinci S system, all completed without conversion to open surgery.<sup>[10](https://pubmed.ncbi.nlm.nih.gov/19879615)</sup> A single Korean institution reported more than 7500 robotic thyroid procedures by July 2020 on the da Vinci Si or Xi platforms.<sup>[11](https://link.springer.com/article/10.1007/s00464-021-08837-9)</sup> Initial experiences with BABA robotic thyroidectomy were reported.<sup>[6](https://www.intechopen.com/chapters/55664)</sup>\n\n### Variants\n\nBeyond the transaxillary and BABA routes, retroauricular (facelift) and transoral (TORT) approaches have been applied safely in patients<sup>[1](https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2023.1196021/full)</sup>, and systematic reviews group robotic cancer surgery into gasless transaxillary, BABA, transoral, and gasless unilateral transaxillary approaches.<sup>[12](https://www.sciencedirect.com/science/article/pii/S1743919121000753)</sup> Gasless unilateral axillary and gasless unilateral axillo-breast modifications of the transaxillary technique also exist.<sup>[5](https://synapse.koreamed.org/articles/1157736)</sup>\n\nThe main recent development is the single-port platform. In the START technique, 200 patients underwent single-port transaxillary robotic thyroidectomy with the da Vinci SP from January 2019 to September 2020, all without open conversion and discharged on postoperative day 3 or 4.<sup>[11](https://link.springer.com/article/10.1007/s00464-021-08837-9)</sup> The da Vinci SP received United States FDA approval in 2018 for urology and in 2020 for selected transoral cases.<sup>[7](https://pmc.ncbi.nlm.nih.gov/articles/PMC12799353/)</sup> Robotic BABA has also been performed on non-da Vinci platforms such as the SSI MANTRA system.<sup>[13](https://www.springermedicine.com/thyroidectomy/thyroidectomy/experience-based-procedure-guide-for-robotic-bilateral-axillo-br/52175170)</sup>\n\n### Applications\n\nIndications and selection. The operation removes one lobe (lobectomy) or the whole gland, with ipsilateral central neck dissection added for cancer; in one single-port series, 190 of 200 patients had thyroid malignancy, and the extent of thyroidectomy followed the 2015 American Thyroid Association guidelines.<sup>[11](https://link.springer.com/article/10.1007/s00464-021-08837-9)</sup> The ideal candidate is not obese, has a small tumor contained within the thyroid gland without thyroiditis, and has good neck and arm mobility without prior neck surgery or irradiation.<sup>[2](https://gs.amegroups.org/article/view/14633/html)</sup> BABA robotic indications include well-differentiated thyroid carcinoma under 4 cm regardless of preoperative lymph node involvement, Graves disease at gland volumes under 100 ml, larger benign nodules of 5–8 cm, and obese patients (BMI >30).<sup>[6](https://www.intechopen.com/chapters/55664)</sup> Absolute contraindications include distant metastasis and medullary, undifferentiated, or poorly differentiated carcinoma located posteromedially near the RLN or invading the tracheal wall; nodules over 8 cm and substernal goiters are relative contraindications.<sup>[6](https://www.intechopen.com/chapters/55664)</sup>\n\nOutcomes. Meta-analyses agree that robotic thyroidectomy takes longer than conventional cervical surgery but disagree on magnitude: 43.5 minutes (95% CI 20.9–66.2) across 18 studies of 4878 patients<sup>[3](https://journals.sagepub.com/doi/10.1177/1553350615613451)</sup> versus 76.7 minutes across 12 studies in a separate review.<sup>[4](https://aao-hnsfjournals.onlinelibrary.wiley.com/doi/10.1177/0194599814521779)</sup> That review found no significant differences in hematoma, seroma, RLN injury, hypocalcemia, or chyle leak rates, and no difference in length of stay.<sup>[4](https://aao-hnsfjournals.onlinelibrary.wiley.com/doi/10.1177/0194599814521779)</sup> A BABA meta-analysis of 2733 patients found equivalent complication rates and surgical completeness but longer operative time, fewer retrieved lymph nodes, and higher cost than open surgery.<sup>[14](https://journals.sagepub.com/doi/10.1177/1553350618817145)</sup> In a prospective 537-case BABA learning-curve study, operative time fell from 189.9 to 129.3 minutes, and RLN adverse events declined from 16.7% to 1.6%.<sup>[15](https://link.springer.com/article/10.1007/s00464-025-12331-x)</sup> For transoral robotic thyroidectomy, a meta-analysis of 10 studies (1420 individuals) found longer operative time, fewer retrieved lymph nodes, and higher cosmetic satisfaction than controls; complication rates were not significantly different, except postoperative infection, which was higher in TORT (OR 10.67, 95% CI 1.24–91.66).<sup>[16](https://www.mdpi.com/2072-6694/14/17/4230)</sup> Against non-robotic [endoscopic thyroidectomy](https://www.edgepedia.org/endoscopic-thyroidectomy), robotic surgery showed a smaller number of cases needed to reach the learning curve (incidence-rate ratio 0.64, 95% CI 0.57–0.72), less intraoperative bleeding (16.56 vs 42.30 ml), and a lower incidence of transient RLN injury.<sup>[17](https://pmc.ncbi.nlm.nih.gov/articles/PMC11745739/)</sup>\n\n### Limitations and alternatives\n\nThe robotic system provides no haptic feedback, which can cause suture breakage during knot tying or tissue rupture while clamping.<sup>[17](https://pmc.ncbi.nlm.nih.gov/articles/PMC11745739/)</sup> The equipment is cumbersome, requiring controllable space and extra time for instrument connections and sterile-envelope preparation, and its cost adds financial pressure on patients.<sup>[17](https://pmc.ncbi.nlm.nih.gov/articles/PMC11745739/)</sup> In one reported comparison, transaxillary robotic thyroidectomy cost $13,670 versus $9,028 for open surgery, driven by equipment depreciation and longer operative times; reaching cost equivalence would require the robotic procedure to be nearly twice as fast.<sup>[2](https://gs.amegroups.org/article/view/14633/html)</sup> The main criticisms of the technique are additional cost, longer operative times, and a steep learning curve.<sup>[2](https://gs.amegroups.org/article/view/14633/html)</sup>\n\nThe remote-access routes are not minimally invasive in the usual sense: they require wide subplatysmal flap dissection, and arm positioning carries a risk of brachial plexus injury if over-extended.<sup>[2](https://gs.amegroups.org/article/view/14633/html)</sup> The nearest alternatives are conventional open thyroidectomy, which needs no special equipment and allows direct palpation, and non-robotic endoscopic techniques such as gasless transaxillary and video-assisted approaches, which share the flap-dissection burden without the robot's articulation and three-dimensional view.<sup>[6](https://www.intechopen.com/chapters/55664)</sup> Single-port platforms have their own constraints: reduced counter-traction, reduced internal workspace, and incomplete integration of advanced energy devices, and adoption remains concentrated in high-volume expert centers.<sup>[7](https://pmc.ncbi.nlm.nih.gov/articles/PMC12799353/)</sup>\n\n### References\n\n1. Remote-access thyroidectomy with the da Vinci SP system: feasibility in a cadaveric model. Frontiers in Surgery. https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2023.1196021/full\n2. Overview of robotic thyroidectomy. Gland Surgery. https://gs.amegroups.org/article/view/14633/html\n3. Robotic Thyroidectomy Versus Nonrobotic Approaches: A Meta-Analysis Examining Surgical Outcomes. https://journals.sagepub.com/doi/10.1177/1553350615613451\n4. Systematic Review and Meta-analysis of Robotic vs Conventional Thyroidectomy Approaches for Thyroid Disease. https://aao-hnsfjournals.onlinelibrary.wiley.com/doi/10.1177/0194599814521779\n5. Review of robotic and endoscopic thyroidectomy approaches. KoreaMed Synapse. https://synapse.koreamed.org/articles/1157736\n6. Bilateral Axillo-Breast Approach Robotic Thyroidectomy: Introduction and Update. IntechOpen. https://www.intechopen.com/chapters/55664\n7. Recent advances in single-port robotic thyroidectomy: evolution, techniques, and clinical outcomes. https://pmc.ncbi.nlm.nih.gov/articles/PMC12799353/\n8. Transaxillary robotic-assisted thyroidectomy (University of Bari repository copy). https://ricerca.uniba.it/retrieve/dd9e0c65-b846-1e9c-e053-3a05fe0a45ef/transaxillary%20robotic-assisted.pdf\n9. Gasless Endoscopic Thyroidectomy Using Trans-axillary Approach; Surgical Outcome of 581 Patients. Endocrine Journal. https://www.jstage.jst.go.jp/article/endocrj/56/3/56_K08E-306/_pdf\n10. Robotic thyroid surgery using a gasless, transaxillary approach and the da Vinci S system: the operative outcomes of 338 consecutive patients. https://pubmed.ncbi.nlm.nih.gov/19879615\n11. Single-port transaxillary robotic thyroidectomy (START): 200-cases with two-step retraction method. Surgical Endoscopy. https://link.springer.com/article/10.1007/s00464-021-08837-9\n12. Surgical outcomes of different approaches in robotic assisted thyroidectomy for thyroid cancer: A systematic review and Bayesian network meta-analysis. https://www.sciencedirect.com/science/article/pii/S1743919121000753\n13. Experience Based Procedure Guide for Robotic BABA Thyroidectomy Using the SSI MANTRA Robotic System. https://www.springermedicine.com/thyroidectomy/thyroidectomy/experience-based-procedure-guide-for-robotic-bilateral-axillo-br/52175170\n14. Meta-analysis Comparison of Bilateral Axillo-Breast Approach Robotic Thyroidectomy and Conventional Thyroidectomy. https://journals.sagepub.com/doi/10.1177/1553350618817145\n15. Learning curve and functional safety in robotic thyroidectomy via bilateral axillo-breast approach: a prospective study of 537 cases. Surgical Endoscopy. https://link.springer.com/article/10.1007/s00464-025-12331-x\n16. Safety and Efficacy of Transoral Robotic Thyroidectomy for Thyroid Tumor: A Systematic Review and Meta-Analysis. Cancers. https://www.mdpi.com/2072-6694/14/17/4230\n17. Comparison of learning curves and related postoperative indicators between endoscopic and robotic thyroidectomy: a systematic review and meta-analysis. https://pmc.ncbi.nlm.nih.gov/articles/PMC11745739/\n\n## References\n\n1. [Remote-access thyroidectomy with the da Vinci SP system: feasibility in a cadaveric model](https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2023.1196021/full)\n2. [Overview of robotic thyroidectomy - Chang - Gland Surgery](https://gs.amegroups.org/article/view/14633/html)\n3. [Robotic Thyroidectomy Versus Nonrobotic Approaches: A Meta-Analysis Examining Surgical Outcomes](https://journals.sagepub.com/doi/10.1177/1553350615613451)\n4. [Systematic Review and Meta-analysis of Robotic vs Conventional Thyroidectomy Approaches for Thyroid Disease](https://aao-hnsfjournals.onlinelibrary.wiley.com/doi/10.1177/0194599814521779)\n5. [Review of robotic and endoscopic thyroidectomy approaches (KoreaMed Synapse)](https://synapse.koreamed.org/articles/1157736)\n6. [Bilateral Axillo-Breast Approach Robotic Thyroidectomy: Introduction and Update (IntechOpen)](https://www.intechopen.com/chapters/55664)\n7. [Recent advances in single-port robotic thyroidectomy: evolution, techniques, and clinical outcomes](https://pmc.ncbi.nlm.nih.gov/articles/PMC12799353/)\n8. [Transaxillary robotic-assisted thyroidectomy (University of Bari repository copy)](https://ricerca.uniba.it/retrieve/dd9e0c65-b846-1e9c-e053-3a05fe0a45ef/transaxillary%20robotic-assisted.pdf)\n9. [Gasless Endoscopic Thyroidectomy Using Trans-axillary Approach; Surgical Outcome of 581 Patients](https://www.jstage.jst.go.jp/article/endocrj/56/3/56_K08E-306/_pdf)\n10. [Robotic thyroid surgery using a gasless, transaxillary approach and the da Vinci S system: the operative outcomes of 338 consecutive patients](https://pubmed.ncbi.nlm.nih.gov/19879615)\n11. [Single-port transaxillary robotic thyroidectomy (START): 200-cases with two-step retraction method](https://link.springer.com/article/10.1007/s00464-021-08837-9)\n12. [Surgical outcomes of different approaches in robotic assisted thyroidectomy for thyroid cancer: A systematic review and Bayesian network meta-analysis](https://www.sciencedirect.com/science/article/pii/S1743919121000753)\n13. [Experience Based Procedure Guide for Robotic BABA Thyroidectomy Using the SSI MANTRA Robotic System](https://www.springermedicine.com/thyroidectomy/thyroidectomy/experience-based-procedure-guide-for-robotic-bilateral-axillo-br/52175170)\n14. [Meta-analysis Comparison of Bilateral Axillo-Breast Approach Robotic Thyroidectomy and Conventional Thyroidectomy](https://journals.sagepub.com/doi/10.1177/1553350618817145)\n15. [Learning curve and functional safety in robotic thyroidectomy via bilateral axillo-breast approach: a prospective study of 537 cases](https://link.springer.com/article/10.1007/s00464-025-12331-x)\n16. [Safety and Efficacy of Transoral Robotic Thyroidectomy for Thyroid Tumor: A Systematic Review and Meta-Analysis](https://www.mdpi.com/2072-6694/14/17/4230)\n17. [Comparison of learning curves and related postoperative indicators between endoscopic and robotic thyroidectomy: a systematic review and meta-analysis](https://pmc.ncbi.nlm.nih.gov/articles/PMC11745739/)\n\n---\n*Topic: Encyclopedia › Life and health › Human health and medicine › Clinical assessment and procedures › Surgery and surgical specialties › Head and neck surgery procedures*\n\n*Initially written Sep 29, 2026 · Edited: Oct 15, 2026*\n\n*Copyright 2026 EdgeChat AI, a subsidiary of Biostate AI.*\n\nLicense: Edgepedia Community License 1.0, https://www.edgepedia.org/edgepedia/license\n",
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 "speakable": "Robotic thyroidectomy is a surgical technique that removes all or part of the thyroid through incisions in the axilla, breast, or behind the ear, avoiding a neck scar."
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