[Surgical characteristics of endoscopic and da Vinci robot-assisted thyroidectomy and the clinical outcomes of thyroidectomy via the unilateral axillary gasless approach].

Objective: To analyze the surgical characteristics of da Vinci robotic and endoscopic-assisted thyroidectomy and compare the clinical outcomes of da Vinci robotic and endoscopic-assisted gasless unilateral transaxillary approach for thyroid surgery. Methods: A retrospective analysis was conducted on patients who underwent da Vinci robotic or endoscopic-assisted thyroidectomyat the Head and Neck Surgery Department of Fudan University Shanghai Cancer Center between July 2020 and June 2024, with follow-up until December 2024. Data on clinicopathological characteristics, operative time, hospitalization costs, surgical complications, and postoperative incision satisfaction were collected and analyzed. Results: During the study period, a total of 618 da Vinci robot-assisted thyroid surgeries and 239 endoscope-assisted thyroid surgeries were performed. In terms of surgical approach, both the robot group and the endoscope group mainly used the unilateral axillary gasless approach: 598 cases (96.8%) in the robotic group and 161 cases (67.4%) in the endoscopic group. The proportion of patients undergoing extended surgical procedures, such as unilateral lobectomy plus ipsilateral central neck dissection (level Ⅵ) and lateral neck dissection, was higher in the robotic group than in the endoscopic group [8.9% (53/598) vs 0.6% (1/161), P<.001]. Regarding the scope of surgery, both groups mainly performed unilateral thyroid lobectomy with ipsilateral level Ⅵ lymph node dissection: 543 cases (87.9%) in the robotic group and 218 cases (91.2%) in the endoscopic group. For patients undergoing unilateral thyroid lobectomy with level Ⅵ lymph node dissection, there were 531 cases in the robotic group [average age (35.4±9.1) years, 92 male] and 154 cases in the endoscopic group [average age (34.5±9.0) years, 13 male]. The robotic group had higher proportions of males [17.3% (92/531) vs 8.4% (13/154)], higher BMI [(22.8±3.6) vs (21.8±3.0) kg/m2], larger tumor diameters [(7.2±3.6) vs (6.5±2.8) mm], higher total costs [(5.5±0.5) vs (2.5±0.7) ten thousand yuan], and more level Ⅵ lymph nodes removed [(3.1±2.3) vs (2.0±1.4)] than the endoscopic group (all P<0.05). The robotic group's surgeries were shorter [(87.4±35.3) vs (127.1±40.2) min], and they had a lower incidence of temporary postoperative hoarseness [1.13% (6/531) vs 3.89% (6/154)] compared to the endoscopic group (both P<0.05). There was no significant difference in postoperative scar satisfaction between the two groups (P>0.05). Conclusions: The gasless unilateral transaxillary approach and unilateral lobectomy plus ipsilateral central neck dissection (level Ⅵ) are the most common surgical approach and extent for da Vinci robotic and endoscopic-assisted thyroidectomy, respectively. Da Vinci robotic surgery is more frequently applied in male patients, higher BMI, larger tumors, and more extensive resections, and it offers superior recurrent laryngeal nerve protection compared to endoscopic systems. However, health economic factors must be considered in practical applications.