Robotic-Assisted Thyroidectomy: The First UK Experience.

Objective: To review our initial experience of robotic thyroidectomy, describe modifications for a Western population, and establish a robust framework for implementation in the UK. Method: Prospective feasibility study (n = 15) performed in a tertiary referral center over 18 months. Procedure-related measures included conversions to open, operative time and the learning curve. Patient-related measures included biometrics, trans-axillary dissection area, voice and swallow function, pain, scar cosmesis, and global quality of life using validated assessment tools. Results: Thyroid lobectomy was performed in 15 patients with no conversions to open. The average BMI was 25.6 (range, 19-35). Mean operative time was 200 minutes. A larger trans-axillary dissection area increased the total operative time. The average size of the excised nodule was 2.5 cm (range, 1.5-6.5 cm). All patients were discharged within 24 hours. No permanent complications occurred. There was 1 temporary brachial plexus neuropraxia which resolved within 5 days. The mean follow-up time was 7 months. The mean scar cosmesis score significantly improved from 56% on day 1 postoperatively to 98% at 12 months (P = .01). Conclusion: Robotic thyroidectomy is feasible for selected patients in the UK. The primary advantage is avoidance of a neck scar. Optimal arm position which minimizes brachial plexus injury is crucial. Validated training methods are necessary for safe adoption. A randomized clinical study will establish the clinical efficacy compared with conventional surgery