Transaxillary Robotic Thyroidectomy: A Novel Technique and Update

Gasless Transaxillary Robotic Thyroidectomy (G-TART) has undergone significant refinement through the adoption of novel strategies to enhance surgical precision and safety. In this paper, we describe a novel technique that integrates dynamic endoscope repositioning, called the "swing technique", with the use of a specialized intraoperative neuromonitoring (IONM) probe-Modena Robotic Probe-designed for robotic applications. The procedure, performed using the Da Vinci Xi system (Intuitive Surgical, Sunnyvale, CA, USA), incorporates intermittent IONM during recurrent laryngeal nerve (RLN) dissection. The swing technique involves real-time adjustment of the 30° endoscope between robotic ports to improve visualization within the confined transaxillary (TA) surgical field, particularly during contralateral dissection. Simultaneously, the Modena Robotic Probe, a custom monopolar stimulation probe developed in collaboration with Dr. Langer Medical GmbH for connection to the AVALANCHE^® SI2 neuromonitor, allows precise RLN mapping and verification throughout the operation. This approach could facilitate accurate anatomical tracking, minimize the risk of thermal or mechanical nerve injury, and enable safe navigation in a narrow operative TA tunnel. The adoption of advanced imaging techniques in conjunction with specialized robotic instrumentation may contribute to enhanced surgical safety and accuracy, emphasizing the importance of procedure-specific robotic approaches in thyroid surgery.