During the last 10 years, advances in laparoscopic and endoscopic techniques have revolutionized minimally invasive surgery. Many studies have concluded that laparoscopic surgery has better surgical outcomes than conventional open procedures in terms of hospital stay, postoperative pain, cosmesis, time required to return to normal activities, and immunologic response. Nevertheless, endoscopic surgery has its limitations because of the technical complexities associated with managing nonflexible endoscopic instruments given a two-dimensional, flat operative view. But the da Vinci surgical robotic system (Intuitive Surgical) substantially overcomes the haptic (nontactile sense), optic (two-dimensional representation), and instrumental limitations of conventional endoscopic procedures, and facilitates minimally invasive surgery. In terms of head and neck surgery, the introduction of robot-assisted techniques have been delayed because of the lack of a preexisting working space, relatively bulky robotic arms in deep, narrow operative fields, and the hypervascularities of target organs, which are invariably surrounded by critical nerves and major vessels.

Over a 10-month period ending in July 2008, we successfully treated 200 consecutive patients by robot-assisted endoscopic thyroidectomy using a novel gasless, transaxillary approach. We describe the technique involved, offer technical tips and details of the pitfalls of robot-assisted endoscopic thyroidectomy using a gasless, transaxillary approach in patients with thyroid cancer, and provide details of short-term surgical outcomes.