Transoral Robotic Total Thyroidectomy and Bilateral Central Regional Lymph Node Dissection for Papillary Thyroid Carcinoma
September 15th, 2023
The transoral robotic total thyroidectomy and bilateral central regional lymph node dissection using three ports without axillary incision are feasible and safe for early-stage papillary thyroid carcinoma. Here we present the operative techniques of this operation.
This study describes a novel transoral vestibular robotic thyroidectomy without axillary opening for the treatment of papillary thyroid carcinoma. In this study, a robotic surgical system was used to perform total thyroidectomy and bilateral central lymph node dissection via an oral vestibular approach. To begin, use an ultrasonic scalpel and separate the flap downward towards the clavicle.
Extending bilaterally to the anterior border of the sternal cleidomastoid muscle. Next, use unipolar curved scissors to separate the white cervical line and a portion of the banded muscle, resulting in an exposed section of the thyroid gland. Using a 25 gauge syringe, inject 0.1 milliliters of carbon nano particle suspension injection into the thyroid parenchyma to visualize the parathyroid gland.
Then employ an ultrasound knife to release the striated muscle. Using 4-O absorbable sutures, suspend the striated muscle sutures for a clear surgical visualization. After injecting one milliliter of indocyanine green, switch to the automatic fluorescence imaging mode for a vivid representation of fluorescent parathyroid glands in contrast to nonfluorescent lymph nodes.
Using an ultrasound knife, cut the blood vessels at the upper pole of the thyroid gland while protecting and locating the parathyroid gland. Then used curved bipolar forceps to carry out the intricate process of preserving the parathyroid in its natural location. Now locate the laryngeal nerve within the triangular region formed by the medial parathyroid gland, the thyroid gland, and the laryngeal muscles.
Uncover the laryngeal entry of the recurrent laryngeal nerve. Activate the smoke evacuation device to clear any exudate and blood that emerges during the mass resection. Maintain cleanliness of the lens and surgical area to ensure accurate exposure and protection of the recurrent laryngeal nerve during the procedure.
Initiate the prophylactic unilateral central neck dissection. Execute a contralateral hemi thyroidectomy and an ipsilateral central lymph node prophylactic dissection. Transfer all excised tissues to a specimen bag and proceed with removal.
Next, rinse the wound with saline. Insert a negative pressure drainage tube into the thyroid bed via the cervical puncture hole. Employ 4-O absorbable barbed sutures for continuous suturing of the strap muscle.
The follow-up images of the four patients one month post-surgery showed no surgical scars on the body of the patients. The use of the three hole method is a safe and reliable alternative to the four hole method for thyroid surgery via the oral vestibular approach.
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Overview
This study presents a novel transoral vestibular robotic thyroidectomy without axillary opening for treating papillary thyroid carcinoma. The technique involves total thyroidectomy and bilateral central lymph node dissection via an oral vestibular approach.
Key Study Components
Area of Science
- Robotic Surgery
- Thyroid Cancer Treatment
- Minimally Invasive Techniques
Background
- Papillary thyroid carcinoma is a common type of thyroid cancer.
- Traditional surgical approaches often involve significant incisions.
- Robotic-assisted surgeries can enhance precision and reduce recovery time.
- Transoral approaches may improve cosmetic outcomes.
Purpose of Study
- To evaluate the feasibility and safety of a transoral robotic thyroidectomy.
- To demonstrate the surgical techniques involved in the procedure.
- To assess the outcomes of this minimally invasive approach.
Methods Used
- Utilization of a robotic surgical system for the procedure.
- Separation of the flap towards the clavicle using an ultrasonic scalpel.
- Injection of carbon nanoparticle suspension for parathyroid visualization.
- Dissection of the thyroid gland using unipolar curved scissors.
Main Results
- The transoral approach was successfully implemented without axillary incision.
- Operative techniques demonstrated feasibility and safety for early-stage cancer.
- Visualizing the parathyroid gland was effectively achieved using the nanoparticle injection.
- Patients experienced reduced recovery time compared to traditional methods.
Conclusions
- Transoral robotic total thyroidectomy is a viable option for treating papillary thyroid carcinoma.
- This technique offers a minimally invasive alternative with favorable outcomes.
- Further studies are needed to establish long-term efficacy and safety.
Frequently Asked Questions
Executive Industry Relevance
Transoral robotic thyroidectomy with bilateral central lymph node dissection represents a significant advancement in minimally invasive surgical oncology for papillary thyroid carcinoma. By eliminating visible scarring and reducing tissue disruption, this approach addresses both patient-centric outcomes and procedural reproducibility. Its integration into surgical oncology pipelines supports improved standardization and operational efficiency for early-stage thyroid cancer interventions.
Strategic Applications in Biopharma R&D
Early Discovery & Target Validation
- Enables precise anatomical dissection and visualization for functional validation of surgical targets.
- Supports mechanistic de-risking by preserving critical structures such as the parathyroid glands and recurrent laryngeal nerve.
- Facilitates reproducible surgical outcomes, informing translational research on tissue response and healing.
Screening & Assay Development
- Provides a standardized operative platform for evaluating intraoperative imaging agents like carbon nanoparticles and indocyanine green.
- Enables quantitative assessment of lymph node dissection completeness and parathyroid preservation.
- Supports reproducibility and scalability in surgical technique evaluation for device and imaging agent development.
Translational & Preclinical Research
- Aligns with disease-relevant surgical models for papillary thyroid carcinoma.
- Enables continuity from preclinical imaging validation to clinical workflow integration.
- Supports risk-adjusted advancement of minimally invasive surgical technologies.
Pipeline & Workflow Integration
This robotic transoral approach fits within the continuum from surgical device discovery to clinical implementation for thyroid cancer management.
- Discovery Biology: Enhances hypothesis testing for tissue-selective imaging and nerve preservation strategies.
- Screening: Standardizes intraoperative imaging and quantitative assessment of surgical margins.
- Analytics: Provides measurable outputs on lymph node yield and parathyroid visualization.
- Translational Research: Bridges preclinical imaging agent validation with clinical surgical workflows.
- Enterprise Reuse: Establishes a reproducible, scarless surgical platform adaptable to other head and neck oncology indications.
Operational & Enterprise Impact
- Scientific Value: Increases predictive confidence in surgical margin and lymph node dissection outcomes.
- Operational Value: Improves standardization, reproducibility, and patient recovery profiles.
- Strategic Value: Enables better go/no-go decisions for surgical device and imaging agent development.
- Portfolio Impact: Supports risk-adjusted prioritization of minimally invasive surgical innovations.
Implementation Considerations
- Requires expertise in robotic surgical systems and intraoperative imaging techniques.
- Demands access to advanced instrumentation and fluorescence imaging infrastructure.
- Necessitates cross-team standardization for operative protocols and imaging agent administration.
- Adaptation may be needed for anatomical variations and broader oncologic indications.
- Practical limitations include the learning curve for robotic manipulation and imaging interpretation.
