Robot-Assisted Transaxillary Total Thyroidectomy for Graves’ Ophthalmopathy after Radio Active Iodine Ablation

      A 63-year-old female with history of Graves’ disease was treated by radioactive iodine ablation. She was referred for worsening exophthalmos, with high TSH receptor autoantibody. Thyroid ultrasound revealed rudimentary lobes bilaterally. A 5 cm incision was done in the right anterior axillary line and a subcutaneous flap was created. The right vagus nerve was stimulated initially, and then the superior thyroid pedicle was dissected and divided. RLN was identified after meticulous dissection and confirmed using the nerve stimulator. The inferior pedicel was dissected and divided, and the right thyroid lobe and isthmus were shaved from the until reaching the contralateral tracheoesophageal groove. Then the left vagus nerve was stimulated followed by identification of the left RLN in the tracheoesophageal groove, which was confirmed by nerve stimulation. Then the remaining small thyroid tissue was dissected circumferentially and from the nerve and the trachea, and the specimen was extracted through the axillary incision.


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