Overall patient satisfaction, assessed by a Visual Analogue Scale (VAS, 0 to 100%) was 94%. A reduction in the Epworth score (mean ESS improvement was 5.9 + 4.4SD) and Apnoea-Hypopnoea Index was seen (mean AHI improvement was 24.6 + 22.2SD). All patients were decannulated between day 4 and 13 after surgery and regained a satisfactory ability to swallow within 2 never weeks. No operative or postoperative complications (10 months of followup) were seen. This study showed the feasibility and safety of robotic tongue base resection techniques. Another cadaveric study conducted at the University of Pennsylvania in 2010 by Lee et al. showed the feasibility of transoral approach for decompression of the craniocervical junction, demonstrating the possible use of the robot in the future for conditions such as compression for basilar invagination, congenital skull base malformations, extradural lesions, and skull-base tumors [46].

7.3. Robot-Assisted Thyroidectomy The transaxillary robotic technique was first described in 2005 by Lobe et al. [47], where a hemithyroidectomy was successfully performed in a pediatric patient. In 2008, the same group reported a bilateral axillary approach for total thyroidectomy in two pediatric patients [48]. In adults, the largest experience in robot-assisted thyroidectomy by Kang et al. who developed the gasless transaxillary technique [49, 50] and reported a series of 338 patients. In 2009, a case control study of 41 robotic cases and 43 conventional thyroid surgery patients was reported [51, 52].

Unlike the transoral technique described previously, this procedure dissects a tunnel on the anterior surface of the pectoralis major muscle and clavicle by electrocautery under direct vision, before the robotic portion of the surgery. With the patient-placed supine under general anesthesia, the neck is slightly extended, and the ipsilateral arm is abducted at the shoulder to minimize the distance between the axilla and neck. A second incision is made on the medial side of the anterior chest wall to insert the 4th robot arm that will be used for thyroid retraction, and it is connected to a continuous suction system. The dissection is approached through the avascular space of the sternocleidomastoid muscle branches and beneath the strap muscle until the contralateral lobe of the thyroid is exposed.

Next, the operation proceeds in the same manner as a conventional open thyroidectomy. Two 8mm instruments are introduced through the breast incision, and the 3rd arm carries the 12mm endoscope [51]. Robotic thyroidectomy using a transaxillary approach leaves Carfilzomib a scar in the axilla that is covered by the patient’s arm. This is important when we consider that thyroid disease is more common in women, and the incidence is increasing in young women, raising concerns about cosmetic results [53].