Single-port transaxillary robotic thyroidectomy and lateral neck dissection: technique, early outcomes, and neuromonitoring

Therapeutic lateral neck dissection is recommended for papillary thyroid carcinoma with clinically evident lateral cervical lymph node metastasis (N1b). Conventional open surgery provides reliable oncologic outcomes but leaves a cervical scar. Remote-access robotic surgery was introduced to avoid a visible neck incision, with subsequent studies reporting comparable lymph node yields. The da Vinci single-port (SP) system delivers wristed instruments and a flexible three-dimensional endoscope through a single 2.5-cm cannula. Early clinical series from experienced Korean centers have reported lateral lymph node yields and short-term complication rates comparable to those of multiport robotic and open approaches, though operative time was initially longer. Intraoperative neuromonitoring (IONM) using the V1-R1-R2-V2 protocol may facilitate recurrent laryngeal nerve identification and functional assessment, while extended stimulation may aid assessment of the spinal accessory and phrenic nerves during lateral neck dissection. However, current evidence remains limited to small, predominantly single-center retrospective series, and no SP-specific IONM outcome data are currently available. Prospective multicenter studies with long-term oncologic follow-up are needed before broader adoption of this technique can be recommended.