Initial clinical experience of a novel single-port axillary to midline (SAM) approach robotic thyroidectomy using a single-port robotic surgical system.

BACKGROUND

Robotic thyroidectomy has evolved through remote-access approaches to improve cosmetic outcomes while maintaining surgical safety. Although the bilateral axillo-breast approach (BABA) provides a stable bilateral operative view, it requires multiple incisions, including periareolar incisions, which may raise cosmetic concerns in some female patients. With the introduction of the da Vinci SP robotic system, we developed the single-port axillary to midline (SAM) approach, a modification of BABA that accesses the thyroid gland through the midline between the strap muscles via a single axillary incision while preserving a stable bilateral operative view. This study evaluated the feasibility, safety, and early clinical outcomes of robotic thyroidectomy using the SAM approach.

METHODS

This retrospective study included 63 patients who underwent SAM approach robotic thyroidectomy between February and September 2025 at Gibbeum Hospital. Demographics, operative time by surgical step, pathology, and postoperative outcomes were analyzed.

RESULTS

Of the 63 patients, 53 (84.1%) were female and 10 (15.9%) were male. Lobectomy was performed in 56 patients (88.9%) and total thyroidectomy was performed in 5 patients (7.9%). The mean total operative time was 147.4 ± 37.5 min, significantly longer in total thyroidectomy than lobectomy (241.0 ± 24.4 vs. 138.4 ± 22.8 min, p < 0.01). Flap creation, docking, and closure times did not differ significantly between the two groups. The mean tumor size was 1.0 ± 0.7 cm; 96.0% of malignancies were papillary thyroid carcinoma. The mean number of metastatic central lymph nodes was 1.3 ± 2.0, with 6.7 ± 4.1 harvested nodes. Transient vocal cord palsy occurred in one patient (1/63, 1.6%), and transient hypoparathyroidism occurred in one patient (1/5, 20.0%), with complete recovery. No major complications were observed. Axillary scars were well concealed within the natural skin crease.

CONCLUSIONS

The SAM approach appears to be a feasible and cosmetically favorable single-port robotic thyroidectomy technique. Further studies are needed to validate long-term oncologic safety.