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<p>Endoscopic thyroid surgery is increasingly used for papillary thyroid carcinoma (PTC), but whether robotic bilateral axillo-breast approach (BABA) offers meaningful perioperative advantages over endoscopic contralateral axillo-bilateral-breast approach (CABBA) for unilateral lobectomy with ipsilateral central lymph node dissection (CLND) is unclear. This retrospective cohort study at Shanghai Sixth People’s Hospital (2021–2025) aimed to compare outcomes between robotic BABA and endoscopic CABBA after lobectomy plus ipsilateral CLND for PTC, stratified by body mass index (BMI: &lt;24 vs. ≥ 24&#xa0;kg/m²). Propensity score matching was applied within each BMI stratum. Among 116 non-overweight patients (BMI &lt; 24; median age 33.0 years; 87.1% female), operative time (150.0 vs. 137.5&#xa0;min; median diff 12.0&#xa0;min; 95% CI 0 to 24; <i>P</i> = 0.087) and central lymph node yield (7.0 vs. 6.0; median diff − 1.0; 95% CI − 3 to 1; <i>P</i> = 0.435) were comparable between robotic BABA and endoscopic CABBA. Robotic BABA was associated with significantly higher cost (median ¥51,394 vs. ¥22,043; median diff ¥29,351; 95% CI ¥26,100–¥32,600; <i>P</i> &lt; 0.001) and longer incision length (median 4.00 vs. 2.80&#xa0;cm; median diff − 1.20&#xa0;cm; 95% CI − 1.20 to − 1.20; <i>P</i> &lt; 0.001). Among 32 overweight/obese patients (BMI ≥ 24; median age 32.0 vs. 31.0 years; 56.3% female), robotic BABA achieved higher central lymph node yield (6.5 vs. 2.5; median diff − 4.0; 95% CI − 8 to − 1; <i>P</i> = 0.003), with comparable operative time (142.5 vs. 140.0&#xa0;min; median diff − 5.0; 95% CI − 20 to 10; <i>P</i> = 0.595) and hospital stay (3.0 vs. 3.0 days; median diff 0; 95% CI 0 to 1; <i>P</i> = 0.147). Endoscopic CABBA retained cost and cosmetic advantages in both strata (both <i>P</i> &lt; 0.001). In non‑overweight patients undergoing lobectomy with ipsilateral CLND for PTC, robotic BABA provides no perioperative advantage over endoscopic CABBA and is less cost‑effective. In overweight/obese patients, robotic BABA improves central lymph node clearance. These findings support BMI‑based patient selection for robotic thyroidectomy.</p>

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Not all patients need a robot: comparative perioperative outcomes of robotic BABA versus endoscopic CABBA thyroid lobectomy with ipsilateral central lymph node dissection, stratified by body mass index

  • 期刊论文

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  • 发表日期：

    2026年7月20日

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  • Ting Yan,
  • Zheng Ding,
  • Rui Xiao,
  • Wangwang Qiu,
  • Bomin Guo,
  • Youben Fan,
  • Jianzhong Di,
  • Zhili Yang

摘要

Endoscopic thyroid surgery is increasingly used for papillary thyroid carcinoma (PTC), but whether robotic bilateral axillo-breast approach (BABA) offers meaningful perioperative advantages over endoscopic contralateral axillo-bilateral-breast approach (CABBA) for unilateral lobectomy with ipsilateral central lymph node dissection (CLND) is unclear. This retrospective cohort study at Shanghai Sixth People’s Hospital (2021–2025) aimed to compare outcomes between robotic BABA and endoscopic CABBA after lobectomy plus ipsilateral CLND for PTC, stratified by body mass index (BMI: <24 vs. ≥ 24 kg/m²). Propensity score matching was applied within each BMI stratum. Among 116 non-overweight patients (BMI < 24; median age 33.0 years; 87.1% female), operative time (150.0 vs. 137.5 min; median diff 12.0 min; 95% CI 0 to 24; P = 0.087) and central lymph node yield (7.0 vs. 6.0; median diff − 1.0; 95% CI − 3 to 1; P = 0.435) were comparable between robotic BABA and endoscopic CABBA. Robotic BABA was associated with significantly higher cost (median ¥51,394 vs. ¥22,043; median diff ¥29,351; 95% CI ¥26,100–¥32,600; P < 0.001) and longer incision length (median 4.00 vs. 2.80 cm; median diff − 1.20 cm; 95% CI − 1.20 to − 1.20; P < 0.001). Among 32 overweight/obese patients (BMI ≥ 24; median age 32.0 vs. 31.0 years; 56.3% female), robotic BABA achieved higher central lymph node yield (6.5 vs. 2.5; median diff − 4.0; 95% CI − 8 to − 1; P = 0.003), with comparable operative time (142.5 vs. 140.0 min; median diff − 5.0; 95% CI − 20 to 10; P = 0.595) and hospital stay (3.0 vs. 3.0 days; median diff 0; 95% CI 0 to 1; P = 0.147). Endoscopic CABBA retained cost and cosmetic advantages in both strata (both P < 0.001). In non‑overweight patients undergoing lobectomy with ipsilateral CLND for PTC, robotic BABA provides no perioperative advantage over endoscopic CABBA and is less cost‑effective. In overweight/obese patients, robotic BABA improves central lymph node clearance. These findings support BMI‑based patient selection for robotic thyroidectomy.