Single-port robotic areolar surgery for thyroid and neck procedures: a 3-year, 500-case single-surgeon experience using the da-Vinci SP system.

Abstract

The single-port robotic areolar approach (SPRA) is a novel remote-access robotic technique using the da Vinci SP system. This study evaluated the feasibility and perioperative safety of SPRA in a large consecutive single-surgeon series and described its procedural spectrum. We retrospectively reviewed 500 consecutive SPRA procedures performed between December 2022 and January 2026. Primary outcomes were perioperative feasibility and safety, including operative variables, vocal cord outcomes, short-term biochemical parathyroid outcomes, and postoperative complications Secondary outcomes included procedural spectrum, including MRND, reoperative surgery, and parathyroidectomy, as well as lymph node yield and short-term serum thyroglobulin values after thyroid cancer surgery. The mean age was 43.1 ± 11.3 years, and 94.8% of patients were female. Lobectomy, total thyroidectomy, total thyroidectomy with MRND, reoperative procedures, and parathyroidectomy were performed in 384 (76.8%), 79 (15.8%), 15 (3.0%), 11 (2.2%), and 10 patients (2.0%), respectively. Transient and permanent vocal cord palsy occurred in 0.6% and 0.2%, respectively. Among total-thyroidectomy-status patients, early postoperative biochemical hypoparathyroidism and persistent early biochemical hypoparathyroidism at 2 weeks were observed in 19.8% and 6.6%, respectively. MRND yielded 31.16 ± 12.71 retrieved and 8.74 ± 5.43 metastatic lymph nodes. At 3 months, 78 of 86 measured patients (90.7%) had unstimulated thyroglobulin < 1.0 ng/mL. SPRA was feasible and showed acceptable perioperative safety in this large consecutive single-surgeon experience. MRND, reoperative surgery, and parathyroidectomy suggest technical expandability, but longer follow-up and multicenter studies are required to evaluate reproducibility and long-term oncologic outcomes.