Robotic Transoral Periosteal Thyroidectomy (TOPOT): Experience in two cadavers

Background: Transoral techniques for endoscopic thyroidectomy have recently been reported, including a robotic transoral technique to access the thyroid gland. Herein, we developed a robotic transoral periosteal thyroidectomy technique. Materials and Methods: The da Vinci® Surgical System (Intuitive Surgical, Sunnyvale, CA) robot was used in two human cadavers to perform robotic transoral periosteal thyroidectomies. In the first cadaver, the anterior neck was exposed below the platysmal muscle. The anatomical spaces and surgical planes were observed with four ports by a periosteal approach. In the second cadaver, robotic transoral periosteal thyroidectomy was performed using three ports. Results: A total thyroidectomy and central neck dissection were performed in two cadavers using the da Vinci robot with the transoral periosteal approach. Complete thyroidectomy and central neck dissection were possible without injury to the recurrent laryngeal nerve. Conclusions: Robotic transoral periosteal thyroidectomy provides superior access to the thyroid and central neck compartment. Transoral thyroidectomy using four ports is a feasible and safe method.