Transaxillary Robotic Total Thyroidectomy for Thyroid Cancer
April 19, 2012
Pier C. Giulianotti (Chicago – USA)
SUMMARY: A 39 years old female presented a 2 cm nodule in the right thyroid lobe. A fine needle aspiration cytology revealed the highest risk for cancer (TIR 4).
The procedure starts with a 5 cm longitudinal incision along the anterior pillar of the right axilla.
A subcutaneous tunnel above the pectoralis major muscle fascia is performed to reach the right lateral cervical region. The access to the right thyroid lobe is achieved between the two head of the sternocleidomastoid muscle.The sternal head of the right sternocleidomastoid muscle and the pre thyroid muscles are lifted by a retractor. The robotic cart is placed near the operative field and the right thyroid lobe is exposed. The thyroid vascular pedicles are isolated and transected by the ultrasonic shears. The parathyroid glands and the laryngeal nerve are well designed and preserved.
After the right lobe mobilization the isthmus (and the right thyroid gland) is sectioned. .The same procedure is performed in the left side and it requires a very good retraction.
After the procedure a Jackson-Pratt drain is placed.
The operative time was 140 minutes. The patient was discharged two days after surgery in good condition. No hypocalcemia and no laryngeal deficit were evident. Final pathological diagnosis was papillary cancer.