DaVinci Robotic BABA Approach for Lateral Neck Dissection in Thyroid Cancer

Abstract

Introduction:

Robotic thyroid surgery has emerged as a transformative advancement in minimally invasive endocrine surgery. The Bilateral Axillo-Breast Approach (BABA), when combined with the da Vinci robotic system, offers enhanced three-dimensional visualization and articulated instrument control, facilitating safe and precise dissection in anatomically complex regions such as the lateral neck^[1-5]. This video demonstrates robotic lateral neck dissection in a 20-year-old patient with papillary thyroid carcinoma.

Methods:

After establishing the working space with air-saline hydro-dissection, preliminary dissection was performed in level Vb to expose Erb’s point and protect the cervical sensory nerves. The lateral neck was then divided into upper and lower compartments using the C3 nerve as a landmark. The upper compartment included dissection of the carotid triangle and level IIb, with particular care taken to preserve the accessory nerve and surrounding vessels. The lower compartment involved systematic clearance of levels III and IV around the venous angle and lymphatic duct, followed by complete dissection of level Vb along the prevertebral fascia, ensuring protection of the phrenic nerve, vagus nerve, and brachial plexus^[3].

Results:

The surgery successfully achieved thorough lateral neck dissection without complications. Postoperative laboratory tests showed parathyroid hormone and calcium levels within normal ranges, suggesting effective preservation of parathyroid function. These outcomes highlight the technical reliability and clinical value of robotic lateral neck dissection via the BABA approach.

Conclusion:

This case demonstrates that robotic lateral neck dissection via the BABA approach is both feasible and safe in selected patients with thyroid carcinoma. Its precise dissection capability and favorable surgical outcomes suggest strong potential for broader clinical adoption in advanced thyroid surgery.

This research was supported by the Fujian Provincial Finance Project (Grant No.: 2023CZ008), the Clinical Research Center for Precision Management of Thyroid Cancer of Fujian Province (Grant No.: 2022Y2006; 2024YGPT003) and Joint Funds for the Innovation of Science and Technology, Fujian Province (Grant No.: 2023Y9190; 2023Y9135; 2023Y9119), and the Education and Teaching Research Project of Fujian Province (Grant No.: YT25002).

The authors declare no competing interests. Author(s) have received and archived patient consent for video recording/publication in advance of video recording of the procedure.

Runtime of video: 6 min 57 sec.

Bo Wang, Xuan Lin and Si-Si Wang contributed equally to this work as co-first authors.