Three-port transoral robotic thyroidectomy without axillary incision: A preliminary report of 20 cases in China

ObjectiveTransoral scarless thyroid surgery has proven to be a popular alternative to traditional approaches. Transoral robotic thyroidectomy (TORT) has been reported using ports on the lower lip and axilla. Avoiding axillary incision can further reduce scars on the armpit. Here, we present our preliminary data from the initial 20 consecutive patients to explore the feasibility of three-port TORT without axillary incision.MethodsFrom September 2017 to June 2019, we performed TORT at Beijing United Family Hospital using three intraoral ports without axillary incision via the da Vinci Si system with three robotic arms. The outcomes of the procedure were retrospectively reviewed.ResultsAmong 20 patients (mean age 30 +/- 7 years; mean tumor size 1.64 +/- 0.96 cm), 16 patients underwent unilateral thyroid lobectomy and four had total thyroidectomy with or without central neck dissection. Eighteen patients had papillary thyroid carcinomas (PTC), one had a follicular thyroid carcinoma, and one had a thyroid adenoma. The mean surgical time was 221 +/- 68 min. The mean number of retrieved central lymph nodes in the PTC patients was 5.6 +/- 5. There was no permanent vocal cord palsy or hypocalcemia postoperatively. One patient had transient vocal cord palsy, which resolved within 1 week. Paresthesia of the lower lip and the chin was observed in nine patients, and one patient had a first-degree burn of the skin flap due to the lens.ConclusionThree-port TORT without axillary incision is feasible for selected patients and would be a potential alternative for remote-access thyroid surgery to avoid leaving scars on the neck or the armpit. Three-port transoral robotic thyroidectomy (TORT) is a skin scar-free surgery that avoids the scar caused by another port through the axilla or the breast. Three-port TORT does not require extensive flap dissection due to the short distance between the intraoral incision and the thyroid gland. Dissatisfaction with cosmetic outcomes and complication rates were low in our cases who underwent TORT. Three-port transoral robotic thyroidectomy without an extra axillary incision is feasible and effective in appropriately selected patients. image