Transoral Robotic Total Thyroidectomy and Bilateral Central Regional Lymph Node Dissection for Papillary Thyroid Carcinoma

This study describes a novel transoral vestibular robotic thyroidectomy without axillary opening for the treatment of papillary thyroid carcinoma. In this study, a robotic surgical system was used to perform total thyroidectomy and bilateral central lymph node dissection via an oral vestibular approach. To begin, use an ultrasonic scalpel and separate the flap downward towards the clavicle.

Extending bilaterally to the anterior border of the sternal cleidomastoid muscle. Next, use unipolar curved scissors to separate the white cervical line and a portion of the banded muscle, resulting in an exposed section of the thyroid gland. Using a 25 gauge syringe, inject 0.1 milliliters of carbon nano particle suspension injection into the thyroid parenchyma to visualize the parathyroid gland.

Then employ an ultrasound knife to release the striated muscle. Using 4-O absorbable sutures, suspend the striated muscle sutures for a clear surgical visualization. After injecting one milliliter of indocyanine green, switch to the automatic fluorescence imaging mode for a vivid representation of fluorescent parathyroid glands in contrast to nonfluorescent lymph nodes.

Using an ultrasound knife, cut the blood vessels at the upper pole of the thyroid gland while protecting and locating the parathyroid gland. Then used curved bipolar forceps to carry out the intricate process of preserving the parathyroid in its natural location. Now locate the laryngeal nerve within the triangular region formed by the medial parathyroid gland, the thyroid gland, and the laryngeal muscles.

Uncover the laryngeal entry of the recurrent laryngeal nerve. Activate the smoke evacuation device to clear any exudate and blood that emerges during the mass resection. Maintain cleanliness of the lens and surgical area to ensure accurate exposure and protection of the recurrent laryngeal nerve during the procedure.

Initiate the prophylactic unilateral central neck dissection. Execute a contralateral hemi thyroidectomy and an ipsilateral central lymph node prophylactic dissection. Transfer all excised tissues to a specimen bag and proceed with removal.

Next, rinse the wound with saline. Insert a negative pressure drainage tube into the thyroid bed via the cervical puncture hole. Employ 4-O absorbable barbed sutures for continuous suturing of the strap muscle.

The follow-up images of the four patients one month post-surgery showed no surgical scars on the body of the patients. The use of the three hole method is a safe and reliable alternative to the four hole method for thyroid surgery via the oral vestibular approach.