Initial learning curve of single-incision transaxillary robotic hemi- and total thyroidectomy – A single team experience from Europe

• The main advantage of transaxillary robotic thyroid surgery is to avoid a neck scar.
• This is associated with potential risks otherwise not present with thyroidectomy.
• The learning curve for transaxillary robotic thyroid surgery is relatively steep.
• Reasonable progress may be achieved within the first 10 cases.
• A consistent team and careful patient selection are paramount.

IntroductionThe primary advantage of robotic thyroidectomy is to avoid a neck scar. On the other hand, this sophisticated technique implies some potential risks otherwise not associated with conventional thyroidectomy, increased costs, and prolonged operating times. With all these factors being an important issue, we analysed the data of our initial European series in order to understand the nature of the learning curve for this technique.MethodsTen patients underwent transaxillary robotic thyroidectomy for benign disease, performed consistently by the same surgeon with the same team, within a timeframe of 12 months. There were four total thyroidectomies and six hemithyroidectomies. Operating times broken down into creating the working space, docking the robot, and console work (including wound closure), were prospectively recorded and evaluated.ResultsBy the end of the initial learning curve comprising ten patients, the total operating time for a robotic hemithyroidectomy and for a total thyroidectomy has decreased by 49% to 190 min, and by 31% to 229 min, respectively. Intraoperative complications were successfully managed without conversion to open access surgery.ConclusionThe learning curve for transaxillary robotic thyroidectomy is rather steep; reasonable progress in terms of operating times can be achieved within the first ten cases. Consistency in the team and careful patient selection are paramount factors for success.