Robotic Bilateral Axillo-Breast Approach

Developed for scarless neck surgery and conceived as a modification of the axillo-bilateral breast approach, the bilateral axillo-breast approach (BABA) is a method of extracervical endoscopic thyroidectomy that is currently one of the most popular endoscopic thyroidectomy techniques in the world. Since the da Vinci robotic system was used to overcome many of the technical disadvantages of BABA endoscopic thyroidectomy, the indications of BABA robotic thyroidectomy(BABA-RT) could be largely extended, and currently include low-risk differentiated thyroid carcinoma <4 cm in diameter, benign thyroid nodule or follicular neoplasm <8 cm in diameter and Graves’ disease. Even modified radical neck dissection can be safely accomplished by BABA-RT. Candidates for BABA-RT should be carefully selected on the basis of thyroid pathology and patient factors. BABA-RT uses a midline approach to the thyroid, which provides a symmetrical view of the thyroid lobes that is similar to open thyroidectomy, so the operation process is familiar to surgeons. Evidence supports that BABA-RT is comparable to the open procedure in terms of completeness of surgical resection and rate of perioperative complications. BABA-RT is safe and feasible when performed by experienced surgeons on carefully selected patients concerned about neck scarring, but more expensive than open or endoscopic surgery.