Microscopic positive surgical margins in robotic thyroidectomy: does robotic approach make a difference?

Microscopic positive surgical margin (mPSM) is a known risk factor of recurrence in patients with differentiated thyroid cancer. While robotic thyroidectomy has gained acceptance as an alternative to open surgery, its impact on margin status remains unclear. This retrospective cohort study analyzed 2587 cases with differentiated thyroid cancer who underwent thyroid surgery between 2009 and 2023. Of these, 206 underwent robotic and 2381 underwent open thyroidectomy. The mPSM rate was comparable between robotic and open groups (4.4 vs. 3.9%, p = 0.743). Multivariable analysis identified larger tumor size, extrathyroidal extension, and multifocality as independent predictors of mPSM, whereas coexisting Hashimoto thyroiditis was associated with a decreased risk. Robotic approach was not an independent risk factor for mPSM (odds ratio 1.647, 95% CI 0.762-3.560). After propensity-score matching, mPSM rates remained similar (4.4% vs 3.4, p = 0.548). In conclusion, robotic thyroidectomy demonstrated oncologic safety comparable to that of open surgery in terms of microscopic margin involvement.