Conventional thyroidectomy through a skin crease incision in the anterior neck sometimes causes a visible scar. Minimally invasive surgical techniques have been developed, and, recently, more various techniques of remote access surgery such as endoscopic and robotic thyroidectomy have been suggested and actively applied. Robotic thyroid surgery has several advantages over endoscopic thyroid surgery. These advantages include three-dimensional magnified view, tremor-filtering system, multi-articulated motion, and more comfortable surgeon position, and assistants are unnecessary for performance of the robotic thyroid surgery.

From November 2008 to July 2014, 256 patients underwent robotic endoscopic thyroidectomies through a transaxillary approach. An approximately 5 cm long incision was created on the axillary natural crease, so that the scar can be completely hidden by the arm. Patients' characteristics, postoperative clinical results, complications, and pathologic details were assessed.

The mean age of patients was 40.9±10.1 years. For benign tumors, we performed 56 less-than total thyroidectomies. For malignant tumors, we performed 175 less-than total thyroidectomies with central compartment node dissection, 21 total thyroidectomies with central compartment node dissection, and four total thyroidectomies with lateral neck node dissection (Benign=56, Malignant=200). The mean actual operation time (console time) was 91.5±48.7 min for benign tumors and 103.0±65.8 min for malignant tumors. The number of retrieved lymph nodes was 5.1±4.1 (mean) in malignant tumors. Internal jugular vein tearing occurred in two patients. Transient hypocalcemia (four patients) and transient hoarseness (six patients) occurred, but recovered within six months.

Robotic endoscopic thyroidectomy is technically safe and feasible and also shows excellent cosmetic outcome.