Single-port robotic areolar thyroidectomy: technical feasibility and clinical outcomes of 64 consecutive cases

Abstract

Abstract Background Single-port robotic areolar (SPRA) thyroidectomy is a recent refinement of the bilateral axillo-breast approach (BABA) that employs the da Vinci single-port system to establish a single-trajectory corridor while preserving a scarless neck. However, clinical data remain limited. The present study evaluated whether SPRA is clinically feasible and technically safe. Methods This retrospective study analyzed 64 consecutive women who underwent SPRA at a single center between March and September 2025. We compared flap dissection extent between SPRA and BABA using a standardized grid-based model and analyzed perioperative outcomes. Console time was stratified by laterality, body mass index (BMI), and learning phase via cumulative sum (CUSUM) analysis. Results Less-than-total and total thyroidectomy were performed in 59 (92.2%) and 5 (7.8%) patients, respectively. The mean console time was 69.3 ± 27.4 min and did not differ significantly by laterality or correlate significantly with BMI. CUSUM analysis showed an inflection point at case 15; the late phase (cases 16–60) had significantly shorter console times than the early phase (cases 1–15) (62.9 vs 82.4 min; mean difference, 19.5 min; p = 0.017). SPRA had an approximately 30% smaller flap dissection area than BABA. No conversions occurred. Transient vocal cord palsy affected six patients (9.4%) and transient hypoparathyroidism affected one (20% of total thyroidectomies), with no permanent complications. Conclusions SPRA demonstrated reduced flap dissection, consistent operative performance, and early stabilization of console time. These findings support SPRA as a safe and feasible integrated platform for remote-access thyroidectomy.