Incidence and clinical course of access-specific morbidity following robotic transaxillary thyroidectomy: a retrospective cohort study of 884 consecutive procedures.
- 1Bizet Surgical Center, Paris, France.
- 2Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel.
- 3Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel.
Abstract
Robotic transaxillary thyroidectomy (RTAT) introduces access-related neurological and sensory outcomes distinct from recurrent laryngeal nerve injury, hypocalcaemia, and haematoma after conventional thyroidectomy. We characterised the incidence, chronological distribution, and clinical course of brachial plexopathy (BP) and descriptively examined working-space dysaesthesia and skin injury. This retrospective cohort included all 884 consecutive RTAT procedures performed at the American Hospital of Paris from 30 April 2010 to 14 October 2019. No eligible procedure was excluded; completion thyroidectomies and conversions remained in the cohort. Most operations were performed by Patrick Aïdan and a smaller proportion by Esmat Najjar. BP was defined by documented ipsilateral upper-limb motor or sensory dysfunction attributed clinically to the transaxillary access or positioning. Working-space dysaesthesia comprised documented altered sensation along the chest, axillary corridor, or pectoral working space. Cases were divided into approximately equal chronological thirds. Among 763 procedures with documented BP status, 13 confirmed events occurred (1.70%; exact 95% confidence interval: 0.91-2.90%); one uncertain entry coded "1?" was excluded. Chronological rates were 8/210 (3.81%), 4/290 (1.38%), and 1/263 (0.38%) in the early, middle, and late thirds, respectively (χ2 P=0.01). Postoperative neurological symptoms were identified during face-to-face clinical assessment by a surgeon on the morning after surgery. Affected patients subsequently underwent routine face-to-face postoperative clinical follow-up by a surgeon within the programme's standard follow-up window of up to 6 months. All 13 had no persistent BP-related neurological deficit at final assessment. Management consisted of physiotherapy and pain management. Exact resolution times were documented in five cases: 3 weeks, 8 weeks, 8 weeks, 8 weeks, and 2 months. Working-space dysaesthesia was documented in 136 symptom-reporting patients; systematic cohort-wide surveillance was unavailable, precluding an incidence estimate. One skin injury was documented among 844 procedures with recorded status. BP was uncommon and concentrated in earlier chronological cases, but the small event count and retrospective ascertainment preclude causal inference. Protected positioning and somatosensory evoked potentials monitoring were programme practices, not interventions proven effective by this analysis. Prospective standardised neurological and sensory surveillance is needed.
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BibTeX
@article{aidan2026incidence,
title = {{Incidence and clinical course of access-specific morbidity following robotic transaxillary thyroidectomy: a retrospective cohort study of 884 consecutive procedures.}},
author = {Patrick Aïdan and Mor Shaked Shukrun and Razan Masarwy and Nir Tzur and Esmat Najjar},
journal = {Gland surgery},
year = {2026},
month = sep,
doi = {10.21037/gs-2026-0341},
url = {https://europepmc.org/article/MED/42996871},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Incidence and clinical course of access-specific morbidity following robotic transaxillary thyroidectomy: a retrospective cohort study of 884 consecutive procedures.
AU - Patrick Aïdan
AU - Mor Shaked Shukrun
AU - Razan Masarwy
AU - Nir Tzur
AU - Esmat Najjar
PY - 2026
DA - 2026/09/28
JO - Gland surgery
DO - 10.21037/gs-2026-0341
UR - https://europepmc.org/article/MED/42996871
AB - Robotic transaxillary thyroidectomy (RTAT) introduces access-related neurological and sensory outcomes distinct from recurrent laryngeal nerve injury, hypocalcaemia, and haematoma after conventional thyroidectomy. We characterised the incidence, chronological distribution, and clinical course of brachial plexopathy (BP) and descriptively examined working-space dysaesthesia and skin injury. This retrospective cohort included all 884 consecutive RTAT procedures performed at the American Hospital of Paris from 30 April 2010 to 14 October 2019. No eligible procedure was excluded; completion thyroidectomies and conversions remained in the cohort. Most operations were performed by Patrick Aïdan and a smaller proportion by Esmat Najjar. BP was defined by documented ipsilateral upper-limb motor or sensory dysfunction attributed clinically to the transaxillary access or positioning. Working-space dysaesthesia comprised documented altered sensation along the chest, axillary corridor, or pectoral working space. Cases were divided into approximately equal chronological thirds. Among 763 procedures with documented BP status, 13 confirmed events occurred (1.70%; exact 95% confidence interval: 0.91-2.90%); one uncertain entry coded "1?" was excluded. Chronological rates were 8/210 (3.81%), 4/290 (1.38%), and 1/263 (0.38%) in the early, middle, and late thirds, respectively (χ2 P=0.01). Postoperative neurological symptoms were identified during face-to-face clinical assessment by a surgeon on the morning after surgery. Affected patients subsequently underwent routine face-to-face postoperative clinical follow-up by a surgeon within the programme's standard follow-up window of up to 6 months. All 13 had no persistent BP-related neurological deficit at final assessment. Management consisted of physiotherapy and pain management. Exact resolution times were documented in five cases: 3 weeks, 8 weeks, 8 weeks, 8 weeks, and 2 months. Working-space dysaesthesia was documented in 136 symptom-reporting patients; systematic cohort-wide surveillance was unavailable, precluding an incidence estimate. One skin injury was documented among 844 procedures with recorded status. BP was uncommon and concentrated in earlier chronological cases, but the small event count and retrospective ascertainment preclude causal inference. Protected positioning and somatosensory evoked potentials monitoring were programme practices, not interventions proven effective by this analysis. Prospective standardised neurological and sensory surveillance is needed.
SN - 2227-684X
SN - 2227-8575
ER -