New Technique Using the Snake Retractor for Complete Lymph Node Dissection in Robotic Thyroid Surgery

Abstract

PURPOSE: We introduce a new technique using a snake retractor to allow for a complete central lymph node dissection (CND) under a more optimal view for robotic thyroid surgery using bilateral axillo-breast approaches. METHODS: Fifty-eight patients diagnosed with papillary thyroid cancer who underwent robotic thyroidectomy from April to December 2010 were analyzed. A total of 20 patients underwent a robotic surgery without use of snake retractor initially, and 38 patients underwent surgery using snake retractor. Ipsilateral CNDs were performed in all cases. RESULTS: The number of harvested lymph nodes was 5.3 without use of the snake retractor and 7.9 with use (P = 0.04). Serum thyroglobulins off thyroid hormone in total cases were 0.6 and 0.2, respectively (P = 0.42). The rate of postoperative complications including transient hypocalcemia (n = 8) and transient recurrent laryngeal nerve palsy (n = 2) were low between the 2 groups without a significance. CONCLUSIONS: Utilization of the snake retractor facilitated safely effective CND with using of 2 arms simultaneously, while providing a superior view to that obtained with robotic thyroid surgery using bilateral axillo-breast approach.