Bilateral Axillo-Breast Approach Robot-Assisted Endoscopic Modified Radical Neck Dissection

Abstract

Abstract

Background:

Robot-assisted bilateral axillo-breast approach (BABA) is one of the well-established remote-access thyroidectomy techniques for both benign and malignant thyroid disorders. However, limited data exist on the role of BABA technique in management of metastatic thyroid cancers in the lateral neck.

Methods:

The aim of this video is to provide a step-by-step overview of the BABA robot-modified radical neck dissection (MRND) and the utilization of intraoperative nerve monitoring during the robotic procedure for a lateral neck thyroid cancer recurrence.

Results:

Two incisions are placed along the medial aspect of each areola (12 and 8 mm) and two incisions are placed in the skin creases at the anterior aspect of the axilla (8 mm). After creation of a subcutaneous and subplatysmal working space over the postsurgical thyroid bed and the lateral neck, selective lateral neck lymph-node dissection was performed along the levels II, III, and IV. The BABA neck dissection was performed without any complications and total of 59 lymph nodes were harvested, of which 2 lymph nodes were positive for cancer. No drain was placed, and the patient was discharged home in 2 days.

Conclusion:

This is the first BABA robot-assisted endoscopic MRND case in the United States. This case demonstrates the feasibility and efficacy of the BABA MRND technique that provides excellent observation of the anatomic structures, adhering to important principles of thyroid surgery. The technique facilitates a complete anatomic dissection while conferring excellent cosmetic and confidential benefits.

The authors have no conflicts of interest or financial disclosures to report. There was no funding received for this study.

Runtime of video: 9 mins