Video-Assisted and Robotic Thyroidectomy

Thyroid surgery has recently seen a number of important advances. The latest addition to the armamentarium of head and neck and thyroid surgeons relates to remote-access robotic thyroidectomy. Robotic assistance overcomes the technical limitations associated with conventional endoscopic surgery and obviates the need for a neck scar, the primary limitation of video-assisted thyroidectomy. With robotic assistance, ergonomics and visualisation are greatly enhanced, thus permitting the translocation of the scar to a remote, ‘hidden’ area. Various approaches have been described utilising the transaxillary, facelift and transoral routes. Each has its own advantages and limitations; none is overwhelmingly superior. The most widely employed technique relates to transaxillary robotic thyroidectomy, for which there is now evidence to support its safety, feasibility and superior cosmesis without compromising outcomes in selected patients. This chapter presents a step-by-step, detailed pictorial narrative of the surgical technique for transaxillary robotic thyroidectomy and discusses important topics around this novel procedure, including preoperative considerations and patient selection, informed consent, surgical complications unique to this approach and how to manage them, as well as training and credentialing in robotic thyroid surgery.