Initial experience with the Carina™ platform for gasless transaxillary robotic thyroidectomy in papillary thyroid carcinoma: an early feasibility report.

INTRODUCTION: Rapid evolution in robot-assisted surgery have advanced the development of modular robotic platforms as innovative solutions. While several modular platforms have been reported in diverse surgical fields, their application in thyroidectomy remains unexplored. Here, we evaluated the feasibility and safety of the Carina™ modular robotic system for thyroid surgery.

METHODS: This preliminary prospective, single-arm study involved pre-clinical validation using porcine and cadaver models, followed by clinical implementation. Seven patients diagnosed with papillary thyroid cancer and scheduled for endoscopic thyroidectomy underwent gasless transaxillary robot-assisted thyroidectomy using the Carina™ platform. Surgical outcomes were analyzed to assess the feasibility and safety of the platform.

RESULTS: Seven patients underwent gasless transaxillary robot-assisted unilateral lobectomy and central neck dissection, without conversion to open or conventional endoscopic surgery. The mean system preparation time was 10.43 ± 3.99 (7-17) min, teleoperation time was 116.14 ± 24.20 (80-151) min, and operative time was 196.43 ± 29.40 (150-230) min. The physical and mental stress load scores of the surgeons were low. The average number of retrieved central lymph nodes was 6.14 ± 2.91 (2-11) with 1.00 ± 1.83 (0-5) metastatic nodes. Transient paresthesia was the most common complication in the subclavian skin region, but no severe complications were observed.

CONCLUSION: This preliminary study suggested that the Carina™ system is a feasible and safe method for unilateral thyroidectomy with central lymph node dissection in highly selected low-risk thyroid surgery patients, with acceptable operative times and no severe complications in this initial clinical series.