The transaxillar robotic technique is suitable mainly for the extirpation of nodular goitre (enlargement of thyroid glands caused by the presence of nodules inside them), of thyroid follicular carcinomas no greater in size than 2 cm. and without extracapsular extension, and of adenomas of the parathyroid glands (hyperparathyroidism). It involves a procedure that is particularly advantageous for patients of slight build and who have a thyroid nodular pathology.
According to the otorhinolaryngological specialist, Juan Alcalde, robotic thyroid surgery means “on the one hand, an important technological advance because, without the precision thereof, it would be too difficult to carry out this technique with a single incision in the axilla. On the other, it provides great aesthetic benefit due to the scar being hidden”. Despite the important advances over recent years towards minimally invasive thyroid surgery, the specialist pointed out that, “although the aesthetic result of conventional surgery in general leaves the neck in an acceptably good condition, on occasions it can give rise to a hypertrophic scar or a scar adherence on the underlying muscular plane, with concomitant aesthetic deterioration”.
The robotic technique takes the place of a cervical incision with a transaxillar approach, carrying out a 6 cm incision which is hidden within the folds of the axilla.
The surgical dissection from the axilla is undertaken in the subcutaneous plane and as far as the cervical and thyroid region. Thanks to the excellent visualization of the robotic equipment and the precision achieved by instruments such as the “harmonic” scalpel — which divides and seals the vascular structures and is especially designed for this surgery — the extirpation of the thyroid glands can be effected. In these cases, robotic surgery takes approximately an hour longer than conventional thyroid operations because, from the axilla to the thyroid gland the surgical route is longer. However, doctor Alcalde stresses that, with the transaxillar procedure “the surgery time for exeresis (extirpation) of the gland in cases where a hemithyroidectomy (surgical extirpation of half of the gland), is similar to that employed in classical techniques, with identical anatomical preservation of the structures surrounding the gland”.
In essence, in an operation for this pathology, the Da Vinci robot “provides good vision and excellent handling of the instrumentation required for introducing gas, as is required with laparoscopic techniques”, pointed out doctor Alcalde.
Reference in robotic surgery
The University of Navarra Hospital has proven experience in the surgical treatment of various pathologies using robotic surgery. Besides the radical prostatectomy operation for surgically treating prostate cancer (also widely used in other hospitals with Da Vinci), specialists at the University Hospital were the first to operate with the robot in Obstructive Apnea Sleep Syndrome, by means of the partial extirpation of the amigdala lingual (tonsil), the approach being through the oral cavity (transoral). They were also the first surgeons in Spain to operate with robotic surgery on cancer of the larynx using the same transoral approach.
- Internet reference
- Jesús Zorrilla Ruiz
- Clínica Universidad de Navarra
- Contact details:
- (+34) 948-296.497 / 948-255.400