Robotic-Assisted Breast-axillo Insufflation Thyroidectomy (RABIT)

Objective: robotic-assisted breast-axillo insufflation thyroidectomy (RABIT) mimics open thyroidectomy. We made modifications to our procedure to evaluate the safety, feasibility, and efficacy of RABIT in patients with differentiated thyroid cancer and benign thyroid nodules larger than 4 cm. Methods:

In this single-center, retrospective, observational case series, patients who underwent RABIT procedures at Fortis hospital, Bangalore from June 2018 to March 2022 were included. Pre-operative vocal cord assessment was carried out by laryngoscopy. RABIT procedure was performed using robotic surgical system with a single docking method using CO2 insufflation. Data regarding demography, clinical, radiological, pathological features, treatment history, intra-operative findings, and postoperative complications were collected from the hospital database.

Results:

RABIT was performed on 50 patients; 29 (58 %) underwent total thyroidectomy and 7 (15.2%) underwent hemithyroidectomy. The median age of patients was 34 (14-65) years, the number of females was 38, and the median tumor size was 2.79 cm (2 mm to 6 cm). The median operative time was 4 hours 9min (1 hour 30 min to 6 hours 40 min) and the average blood loss was 131.4 mL (30 – 250 mL). Recurrent laryngeal nerve was identified and preserved in all patients; superior laryngeal nerve was identified in 33 (66%) patients and parathyroid was identified in 35 (70%) patients. The median hospital stay was 5 (3-14) days and postoperatively, transient symptomatic hypocalcemia was detected in 14 patients and 1 patient had permanent hypoparathyroidism requiring long-term calcium supplementation.

Conclusion:

We successfully employed the modified RABIT approach in this consecutive case series to dissect differentiated thyroid carcinoma with thyroid size up to 6 cm and benign thyroid nodule up to 8 cm. Our technique described herein provides a symmetrical view of both thyroid lobes similar to that of open thyroidectomy technique, maintains specimen integrity, and comparable surgical completeness, adverse effect to open thyroidectomy with excellent cosmesis.