Robotic Thyroid Surgery using Da Vinci Robot The Da Vinci operating robot with its 4 arms used in Robotic Scarless Thyroid Surgery.

Overview of Robotic Thyroid Surgery

When we talk about using a "robot" in surgery, or "robotic" thyroid surgery we are referring to a very advanced operating machine that has multiple "arms" that are attached to long instruments. The surgeon makes small incisions in the armpits of the patient and the "arms" of the robot are placed into these incisions. Once all the robot "arms" are placed into their incisions the surgeon walks a few feet away from the patient and sits at a control console that allows him/her to manipulate all of the arms at the same time. It's like we magically made a very talented surgeon with two arms and hands into a surgeon with 4 arms and 4 hands. This provides better exposure to the tissues and allows a more detailed operation for many patients.

How is Robotic Thyroid Surgery Performed?

Robotic thyroid surgery is performed under the comfort of general anesthesia just like routine thyroid surgery. Also, the positioning during your surgery will be essentially the same as it is in traditional thyroid surgery with the patient laying on their back. But the big difference is the scar is placed away from the neck because the instruments are long. In robotic scarless thyroid surgery, a total of four small 8-10mm (1/4 to 1/2 inch) incisions will be made along the skin folds of left and right armpits and areolar margins. Robotic Thyroid Surgery Port Placement The drawing above shows where four small cuts are made in the skin, one in each arm pit, and one on the side of the areolas. Then the robotic instruments are placed through the fat layers under the skin to reach the front of the neck under the skin.

Once the robotic "arms" are but through the skin incisions in the arm pit and under the skin to reach the front of the neck, the rest of the surgery is performed all robotically--which means the surgeon sits at a "console" as shown in the photo where advanced cameras show amazing detail of the thyroid and surrounding tissues. Robotic thyroid surgery is enhanced by the latest technology which includes a 3D high definition camera with >10-fold magnification and robotic instruments such as advanced energy devices for safe tissue cauterization and dissection. The two opposing instruments from the left and right armpits provide ideal traction and counter-traction for optimal exposure. Visualization is key in all surgery. The arrangement of the four instruments in the BABA technique is ideal for triangulation between the camera and the robotic instrument. This provides precise depth perception during the surgery leading to the highest surgical precision.

The surgeon sits at a "console: near the patient and controls the robotic instruments. Ergonomic design with customized headrest, armrest, and 3D vision panel provides maximum comfort for the surgeon. This gives the surgeon 4X magnification and a view of the tissus that cannot be seen with any other operation.

Is Robotic Thyroid Surgery Minimally Invasive Surgery?

Yes, Robotic scareless thyroid surgery is minimally invasive. Regardless of the size of the goiter, thyroid nodule, or the extent of the thyroid cancer, all dissections are done through the small minimally invasive incisions. The instruments are secure and fixed to the robotic arms minimizing the trauma and unnecessary stress to your body.

Is Robotic Thyroid Surgery Safe for my Vocal Cord Nerves?

In all types of thyroid surgery, preserving your voice is paramount. Early identification and preservation of the voice box nerves called the recurrent laryngeal nerve are essential in every single thyroid surgery. It is even more important when both sides of the neck are operated on and the entire thyroid gland removed for thyroid cancer, multinodular goiter, or hyperthyroidism due to Graves disease beacuse both your left and the right recurrent laryngeal nerves are at risk of injury. In robotic thyroid surgery, the vocal cord nerves are seen very early in the operation using the robotic camera along with refined dissection of the nerve using the robotic instruments. In fact, a skilled robotic surgeon can find the vocal cord nerves much more quickly and accurately than what is expected in the usual open (big neck scar) operation. Thus, the function of the recurrent laryngeal nerve, and your voice quality can be optimally preserved using the robot in nearly 100% of cases. In every robotic thyroid surgery, a nerve monitoring device is used to detect and test the function of the nerve.

Dr Suh uses Amniotic Membrane to help preserve vocal cord function. Recent studies at Yale University and the Clayman Thyroid Cancer Center have shown using amniotic membrane placed upon the vocal cord nerves can help preserve vocal cord function and prevent injury. Dr Suh uses amniotic membrane in all his scarless thyroid surgery operations where the vocal cord nerve is exposed for this reason. The amniotic membrane contains stem cells and growth factors that have been shown to protect the nerve and help preserve function. Even if you don't have Dr Suh perform your operation, make sure your surgeon uses amniotic membrane to help preserve your vocal cord nerves.

Does Robotic Thyroid Surgery Help Save the Parathyroid Glands?

Parathyroid glands control the blood calcium and thus are at high risk of injuray during thyroid surgery. There are two parathyroid glands on each side adjacent to the thyroid gland. Parathyroid glands are intimately associated with the thyroid gland in that they share same the same blood supply. Sometime parathyroid gland can be embedded in the thyroid gland. Again, good visualization and careful dissection of the parathyroid gland are paramount in preserving the function of the parathyroid gland and therefore, avoiding the complication related to low parathyroid hormone leading to low blood calcium levels. Damage to the parathyroid glands can be a terrible problem for patients after thyroid surgery, and thus early identification and precise dissection is the key to preventing such complication--things that are made EASIER with the operating robot.

After Robotic Thyroid Surgery, How do you get the Thyroid Out?

Robotic Thyroid Surgery Specimen Bag Once the surgery is completed, the surgical specimen (i.e. thyroid nodule, cancer, or lymph node) will be removed cleanly in a specimen bag (shown in the photo) via one of the armpit incisions. Even a large specimen can be removed easily through the armpit incision given the laxity of the skin in the armpit region. If needed, the armpit incision can be extended in a hidden fashion to remove larger specimens. The subcutaneous skin space will heal quickly. The four small incisions will heal within a few days. Skin glues are applied to the incisions, and no suture removal is necessary after the surgery

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