Endocrine Abstracts

Backgound: Constant developments in minimally invasive surgery are being made with thyroid surgery being no exception. Robotic thyroidectomy by transaxillary approach (RATS) is considered a safe alternative for selected patients with benign disease or low risk thyroid cancer.

Aim: We aim to present the case of the first Robotic Transaxillary Thyroidectomy performed in a public Portuguese Hospital, discuss its advantages and disadvantages and the challenges of introducing a minimal invasive cervical program in the public healthcare system.

Methods: A 61-year-old women with a 15 × 9 mm left isthmic thyroid nodule, regular margins and no microcalcifications, with a fine-needle aspiration cytology revealing a follicular neoplasm is proposed for a Robotic Transaxillary Thyroidectomy.

Results: The patient underwent a hybrid, robotic assisted, left thyroidectomy. The surgery was performed with the use of the Modena Retractor, Intraoperative Nerve-Monitoring and Indocyanine Green vascular test, thanks to the integration of the firefly technology in the Da Vinci robotic system. With an approximate over-all intra-operative time of 3 hours, 20 cc of blood loss and no intra-operative complications. The patient was discharged 36 hours after the procedure.

Discussion and Conclusion: The robotic technology offers an image enhanced perspective of the cervical structures, allows for more precise movements and minimal dissection. With the incorporation of other technology such as nerve-monitoring and ICG test, it helps guarantee the safety of the procedure. There is minimal post-operative pain and no visible cervical scar. It is, however, associated with an important learning curve and increased cost when compared with other approaches. The minimally invasive surgery is the future of thyroid and cervical surgery, with robotics surgery having an important role to play. Medical professionals and healthcare institutions should be familiarized with this option, its advantages and disadvantages, as it becomes more popularized and demand increases.