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

The Invisible Scar: A New Way to Hide Thyroid Surgery

Imagine your body is a house, and sometimes, a room inside needs a major renovation. In the case of the thyroid—a small, butterfly-shaped gland in your neck that acts like the house's thermostat—doctors often need to remove part or all of it to fix problems. For decades, the standard way to do this was to cut right across the front of the neck. While effective, this leaves a visible scar, like a permanent sticker on the front door. For many people, especially young women, this cosmetic mark is a big deal, leading to the development of "remote-access" surgeries. These are like sneaking into the house through the back door or a hidden window so the front remains untouched.

One popular method, called the Bilateral Axillo-Breast Approach (BABA), uses two tunnels: one from under the arm and one from the side of the breast. It works well, but it requires digging a wide path through the skin and fat to get the tools in, kind of like clearing a wide driveway just to park a single car. Recently, a new, high-tech tool called the da Vinci SP system arrived. Think of this robot as a super-flexible, three-dimensional snake that can fit through a tiny hole and still do complex work with its "wristed" hands. This paper explores a new technique called Single-Port Robotic Areolar (SPRA) thyroidectomy. Instead of two tunnels, it uses just one tiny door right next to the nipple, sending the robot in to do the job. The big question is: Can this single, tiny entry point do the heavy lifting safely, and does it actually cause less damage to the "driveway" (the tissue under the skin) than the older, wider methods?

The Experiment: One Door, One Robot, 64 Patients

The researchers at Inje University Haeundae Paik Hospital decided to test this new "single-door" strategy on 64 women between March and September 2025. They wanted to see if the SPRA method was safe, if the surgeons could get faster at it, and if it really saved the patient from having to cut up a large area of skin.

The Setup and The Team
The team was made up of surgeons who were already experts at the older, two-door method. They used the da Vinci SP robot, which fits through a single 3-centimeter incision (about the size of a large coin) right next to the areola. They also added one tiny 8-millimeter helper port under the arm. The goal was to see if they could remove the thyroid (or just part of it) without ever touching the front of the neck.

The Results: Speed, Safety, and Less Digging
The study found that the new method worked surprisingly well. Here is what happened:

• No Conversions: In every single one of the 64 cases, the surgeons finished the job using the robot. They didn't have to stop and switch to a big open cut or a different type of surgery.
• Learning Curve: At first, the robot took a bit longer to operate. The average time the surgeon spent controlling the robot (called "console time") was 69.3 minutes. However, the team got much faster after the first 15 cases. After that point, the average time dropped to 62.9 minutes, while the early cases took 82.4 minutes. This suggests that once the team got used to the new tool, they became very efficient.
• The "Driveway" Size: One of the most interesting findings was about how much skin and fat they had to move aside to get to the thyroid. The researchers used a special grid to measure the area they had to dissect (cut and move). They found that the SPRA method required about 30% less dissection area than the older two-door method. It's like needing a much smaller driveway to park the car, which means less trauma to the body.
• Body Size Didn't Matter: They wondered if being heavier would make the surgery harder or slower. They checked the Body Mass Index (BMI) of the patients, which ranged from 16.2 to 42.3. The data showed that the robot's speed did not slow down for heavier patients. Even a patient with a BMI of 42.3 had a successful surgery.
• Left vs. Right: It didn't matter if the tumor was on the left or right side of the neck; the surgery took about the same amount of time for both.

The Complications
Safety is the most important part. The study reported:

• Voice Nerves: Six patients (9.4%) had temporary hoarseness because the nerve controlling their voice got a little irritated. However, everyone recovered fully within three months. No one had permanent damage.
• Parathyroid Glands: These tiny glands control calcium. Only one patient (who had a total thyroidectomy) had temporary low calcium levels. No one had permanent issues.
• Other Issues: One patient had a small collection of blood (hematoma), and one had a temporary drop in calcium. There were no permanent complications.
• Pain: Patients reported very mild pain. On the day of surgery, the pain score was 3.3 out of 10. By the second day, it dropped to 2.9. While this is a statistically small change, it suggests the recovery was comfortable.

The Look
The most visible result was the scar. Because the cut was hidden next to the nipple, there was absolutely no scar on the neck. One month after surgery, the incision had healed, and the neck looked completely normal.

What This Means

The paper concludes that this new Single-Port Robotic Areolar (SPRA) approach is a safe and feasible way to remove thyroid glands without leaving a neck scar. It suggests that the technique is not only possible but also offers a real advantage by reducing the amount of tissue that needs to be moved aside (the 30% reduction in dissection area).

However, the authors are careful to note that this was a study of 64 women at just one hospital, and the surgeons were already experts in robotic surgery. They didn't compare it directly to the old open surgery in this specific paper, and the follow-up time was relatively short. While the results are promising and show that the robot can handle the job quickly and safely, the authors suggest that more studies with larger groups of people and longer follow-ups are needed to confirm that this is the best option for everyone. For now, it stands as a strong, promising new tool in the surgeon's kit for those who want to avoid a neck scar.