OP70 – Recent Progress of Retroauricular Robotic Thyroidectomy with the New Surgical Robotic System


    Koh, Yoon Woo1, Byeon, Hyung Kwon1, Holsinger, F. Christopher2, Duvvuri, Umamaheswar3, Kim, Da Hee1, Kim, Joo Hyun1, Park, Jae Hong4, Chang, Estelle5, Kim, Se-Heon1
    1 Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea
    2 Division of Head & Neck Surgery, Department of Otolaryngology, Stanford University School of Medicine, Stanford, CA, USA
    3 Department of Otorhinolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
    4 Department of Otorhinolaryngology, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
    5 Department of Otolaryngology Head and Neck Surgery, University of Nebraska Medical Center, Omaha, NE, USA


    Background: Previously, we have reported the feasibility of retroauricular (RA) robotic thyroidectomy. Despite its promising surgical outcomes, there were certain intrinsic mechanical limitations inherent to the da Vinci Si System. Since the advent of an upgraded model, the Xi System, we have actively incorporated the new model into performing RA thyroidectomy. Here, we intend to verify the feasibility of RA robotic thyroidectomy using the new da Vinci Xi System with comparison of the former Si-applied surgery.

    Methods: There were total 165 consecutive patients who received RA robotic thyroidectomy from January, 2013 to February, 2016. The patients were divided into two groups: Si (n=125) and Xi (n=40) group. Perioperative and treatment outcomes were compared and analyzed.

    Results: Compared with the previous system, new da Vinci Xi system enabled insertion of an extra third robotic instrumental arm. Unlike the previous robotic surgical technique, the robotic dissection could be initiated immediately after the establishment of working space and the resulting total operation time could be significantly decreased. There was no difference in the surgical completeness as confirmed by postoperative thyroglobulin levels. Additionally, flexed endowrist instruments equipped with the ERBE® system could be mounted further facilitated the operation. There were no significant differences in postoperative complications between the two groups such as vocal cord palsy, seroma, or bleeding.

    Conclusion: The RA robotic thyroidectomy with the new Xi System can greatly facilitate the robotic surgery with comparable or improved surgical outcomes. Its application is expected to open up a new era of robotic neck surgery.



    1. Byeon HK, Holsinger FC, Tufano RP, et al. Robotic total thyroidectomy with modified radical neck dissection via unilateral retroauricular approach. Ann Surg Oncol 2014;21:3872-3875.
    2. Byeon HK, Kim DH, Chang JW, et al. Comprehensive application of robotic retroauricular thyroidectomy: The evolution of robotic thyroidectomy. Laryngoscope 2016; 126:1952-1957.
    3. Byeon HK, Holsinger FC, Tufano RP, et al. Endoscopic retroauricular thyroidectomy: preliminary results. Surg Endosc 2016;30:355-365.
    4. Koh YW, Choi EC. Robotic approaches to the neck. Otolaryngol Clin North Am 2014; 47:433-454.
      5. Byeon HK, Koh YW. The new era of robotic neck surgery: The universal application of the retroauricular approach. J Surg Oncol 2015;112:707-716.
      6. Kim WS, Byeon HK, Park YM, et al. Therapeutic robot-assisted neck dissection via a retroauricular or modified facelift approach in head and neck cancer: A comparative study with conventional transcervical neck dissection. Head Neck 2015;37:249-254.


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