Ewha Med J.  2024 Jan;47(1):e7. 10.12771/emj.2024.e7.

Bilateral axillo-breast approach robotic total thyroidectomy without isthmectomy: a case report

• Kim H
• Hwang H
• Kwon H

• KMID: 2553299
• DOI: http://doi.org/10.12771/emj.2024.e7

Abstract

Conventional open thyroidectomy is a safe procedure, but it has the disadvantage of leaving noticeable scars on the neck. Bilateral axillo-breast approach (BABA) robotic thyroidectomy was developed as an alternative technique to remove thyroid glands without making incisions in the neck. In traditional BABA robotic thyroidectomy, dividing the isthmus is a routine step to improve the efficiency of the dissection during thyroid surgery. However, there are safety concerns when performing this procedure on patients with thyroid cancer located in the isthmus. We report a case of BABA robotic total thyroidectomy carried out without dividing the isthmus in a patient with isthmic papillary thyroid carcinoma. Our experience suggests that BABA robotic surgery can be a feasible and safe option for selected patients with isthmic papillary thyroid carcinoma.

Keyword

Bilateral axillo-breast approach (BABA) robotic thyroidectomy; Isthmus; Thyroid cancer, papillary

Figure

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  Fig. 1. Thyroid ultrasonography of an isthmic tumor.

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  Fig. 2. Left axillary incision scar after 2 weeks.

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  Fig. 3. Specimen photography showing isthmic thyroid cancer measuring 3 cm.

Reference

References

1. Jung CK, Bae JS, Park YJ. Re-increasing trends in thyroid cancer incidence after a short period of decrease in Korea: reigniting the debate on ultrasound screening. Endocrinol Metab. 2022; 37(5):816–818. DOI: 10.3803/EnM.2022.1586. PMID: 36220136. PMCID: PMC9633216.

2. Choi YM, Lee J, Kwak MK, Jeon MJ, Kim TY, Hong EG, et al. Recent changes in the incidence of thyroid cancer in Korea between 2005 and 2018: analysis of Korean national data. Endocrinol Metab. 2022; 37(5):791–799. DOI: 10.3803/EnM.2022.1533. PMID: 36220137. PMCID: PMC9633217.

3. Song RY, Sohn HJ, Paek SH, Kang KH. The first report of robotic bilateral modified radical neck dissection through the bilateral axillo-breast approach for papillary thyroid carcinoma with bilateral lateral neck metastasis. Surg Laparosc Endosc Percutan Tech. 2020; 30(3):e18–e22. DOI: 10.1097/SLE.0000000000000590. PMID: 30383710.

4. Sarkar S, Banerjee S, Sarkar R, Sikder B. A review on the history of 'Thyroid Surgery'. Indian J Surg. 2016; 78(1):32–36. DOI: 10.1007/s12262-015-1317-5. PMID: 27186037. PMCID: PMC4848216.

5. Arora A, Swords C, Garas G, Chaidas K, Prichard A, Budge J, et al. The perception of scar cosmesis following thyroid and parathyroid surgery: a prospective cohort study. Int J Surg. 2016; 25:38–43. DOI: 10.1016/j.ijsu.2015.11.021. PMID: 26602967.

6. Lee KE, Rao J, Youn YK. Endoscopic thyroidectomy with the da Vinci robot system using the bilateral axillary breast approach (BABA) technique: our initial experience. Surg Laparosc Endosc Percutan Tech. 2009; 19(3):e71–e75. DOI: 10.1097/SLE.0b013e3181a4ccae. PMID: 19542833.