Robotic modified radical neck dissection for thyroid carcinoma using a gas-insufflation one-step single-port transaxillary (GOSTA) approach

Abstract

To evaluate the feasibility, safety, and surrogate oncologic markers of robotic modified radical neck dissection (MRND) using the gas-insufflation one-step single-port transaxillary (GOSTA) approach compared with conventional open MRND. Between January 2018 and December 2024, 69 patients with papillary thyroid carcinoma (PTC) underwent MRND, with 39 patients receiving open MRND (OMRND) and 30 undergoing robotic MRND (RMRND) using the GOSTA approach. Data on clinical and pathological characteristics, perioperative outcomes, and complications were analyzed using statistical tests to compare both groups. The mean operative time was significantly longer in the RMRND group than in the OMRND group (297.8 ± 95.8 min vs. 237.2 ± 128.5 min, p = 0.03). However, there were no significant differences in postoperative hospital stay, unstimulated thyroglobulin (Tg) levels before first RAI, or stimulated Tg levels at the first radioactive iodine (RAI) therapy. The number of harvested and metastatic lateral lymph nodes was comparable between the groups (p = 0.51 and p = 0.31, respectively). The complication rates were similar, with no significant differences in transient or permanent recurrent laryngeal nerve palsy, hypoparathyroidism, or other surgical complications. Robotic MRND using the GOSTA approach is a feasible and safe alternative to open MRND, providing comparable oncologic outcomes with enhanced cosmetic benefits.