Abstract
Introduction:
Robotic thyroid surgery via the Bilateral Axillo-Breast Approach (BABA) has enabled surgeons to perform complex procedures with enhanced precision. In recent years, our center has performed over 900 robotic thyroidectomies, including 124 lateral neck dissection (LND) cases. This video presents the technical standardization, procedural strategy, and surgical advantages of the robotic BABA approach for LND in papillary thyroid carcinoma. Robotic and endoscopic approaches, including the bilateral axillo-breast approach (BABA), have been increasingly adopted for thyroid surgery and lateral neck dissection, with growing evidence supporting their feasibility and safety [1–5].
Methods:
We have developed a standardized seven-step technique for robotic LND. The procedure begins with air-saline hydro-dissection to establish the operative space, followed by preliminary dissection of level Vb to identify Erb’s point and preserve the C4 nerve. Using the C3 nerve as a landmark, the dissection is divided into upper and lower compartments. The upper compartment includes the carotid triangle and level IIb, with critical attention to the accessory nerve. The lower compartment involves clearance of level III and dissection of level IV around the venous angle, with careful protection of the phrenic and vagus nerves. Final dissection of level Vb is completed along the prevertebral fascia.
Results:
Postoperative outcomes demonstrate that robotic LND via the BABA approach is both feasible and safe. The incidence of complications such as postoperative bleeding and chyle leakage remained low, and the number of removed lymph nodes was comparable to that of endoscopic procedures. These findings reflect the procedure’s oncological effectiveness and functional safety.
Conclusion:
The robotic BABA approach offers a structured and reproducible method for LND in thyroid cancer, combining oncological thoroughness with nerve preservation and cosmetic benefits. Its advantages in visualization, stability, and precision support its broader 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 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 mins 57 secs.
