Single-port, via a midline approach, Robotic Transaxillary Thyroidectomy (SMART-Thyroidectomy): description of the technique and evaluation of feasibility in the first case series

The Da Vinci SP system has recently been applied to remote-access robotic thyroidectomy, enabling single-port (SP) surgery with enhanced instrument articulation. We evaluated the feasibility of a novel Single-incision, via a Midline Approach, Robotic Transaxillary Thyroidectomy (SMART-T), which combines the cosmetic advantages of a concealed axillary incision with the bilateral midline exposure provided by the bilateral axillo-breast approach (BABA). A prospective analysis was performed on an initial series of patients who underwent SMART-T between June and July 2026. Demographic, operative, pathological, and postoperative data were collected. Sixteen patients successfully underwent SMART-T without conversion. All patients underwent lobo-isthmusectomy (11 right-sided and 5 left-sided procedures). Mean operative time was 99.6 ± 17.5 min, with mean docking and console times of 5.1 ± 2.0 and 55.6 ± 17.7 min, respectively. Ipsilateral central neck dissection was completed in three patients. One patient experienced transient minimal vocal cord hypomobility that resolved within 7 days. No other complication occurred. Postoperative pain and analgesic requirements were minimal. Subjective voice and swallowing impairment were minimal and completely recovered by postoperative day 7. Cosmetic outcomes were rated as excellent by 87.5% of patients. The present study reports the first European clinical series of SP BABA-derived thyroid procedures. SMART-T is a feasible single-port robotic approach to thyroidectomy that provides a BABA-like midline operative view through a single axillary incision, with encouraging early operative, functional, and cosmetic outcomes that support further evaluation in larger studies with longer follow-up.