Morphometric assessment of dissection fields with robotic thyroidectomy approaches: Pre-clinical investigation

Objectives: Robotic thyroidectomy was introduced in the United States despite scant pre-clinical data. We sought to define differences in the extent of dissection associated with 2 different robotic thyroidectomy techniques using morphometric measurements of the area of dissection required for each approach. Design: Morphometric analysis of human cadavers. Methods: Seven fresh human cadavers were obtained for surface anatomical study. Using previously defined landmarks, the area necessary to accomplish robotic thyroidectomy using either the transaxillary or facelift approach was marked in a standardized fashion for these procedures and then photographed. ImageJ software (National Institute of Health) was used to calibrate the photographs and measure the surface area of the region requiring dissection in each approach. Results: A total of 28 robotic thyroidectomy dissection pockets were simulated (14 for each of the 2 surgical approaches) with each specimen serving as its own control. The mean area of dissection required for RFT was 39.2 ± 6.6 cm² (range 25.2 to 47.9 cm²). For RAT, the area was 38.3% greater on average (p<0.0001): the mean was 63.5 ± 9.6 cm² (range 52.3 to 83.6 cm²). Conclusions: There are few objective data governing the recent adoption of technology-intense robotic thyroidectomy procedures. We have quantified the difference in dissection required when accomplishing two different robotic approaches. These measurable differences may help to define advantages when comparing available surgical techniques.