Robotic facelift thyroidectomy: I. Preclinical simulation and morphometric assessment

Objectives: Robotic thyroidectomy was introduced in the United States despite scant preclinical data. We pursued a systematic preclinical investigation of a new remote access, robotic thyroidectomy technique via a facelift incision, and sought to define differences in extent of dissection associated with this approach and a second, popular robotic thyroidectomy technique. Design: Surgical simulation and morphometric analysis in fresh human cadavers. Methods: Eleven specimens were obtained to complete four experiments designed to address two specific aims: to develop a reproducible surgical protocol for robotic removal of the thyroid through a facelift incision, and to quantify the extent of dissection required with two robotic thyroidectomy techniques. Results: The feasibility of the facelift approach was determined using an endoscopic technique, and two lobectomies were accomplished. Inanimate study of the optimal robotic positioning to facilitate resection was then completed. Three additional cadavers were used to develop a reproducible surgical protocol and define a stepwise algorithm of dissection. Seven specimens were used to simulate 28 robotic thyroidectomy dissection pockets. The mean area of dissection required for robotic facelift thyroidectomy was 39.2 ± 6.6 cm² compared with 63.5 ± 9.6 cm² for robotic axillary thyroidectomy, representing a difference of 38.3% (P <.0001). Conclusions: We have described and refined a reproducible surgical protocol for accomplishing a new robotic facelift thyroidectomy, and then quantified the reduced dissection required when comparing it with a transaxillary technique. Cautious clinical implementation to explore safety and feasibility appears to be justified.