# Transaxillary Robotic Thyroidectomy: A Novel Technique and Update

## TL;DR

A new robotic thyroid surgery technique combines dynamic camera adjustments and a specialized nerve monitoring probe to improve precision and safety.

## Contribution

A novel swing technique and custom neuromonitoring probe are introduced for robotic thyroidectomy.

## Key findings

- The swing technique improves visualization during contralateral dissection in a confined surgical field.
- The Modena Robotic Probe enables precise recurrent laryngeal nerve mapping and injury prevention.
- Combining advanced imaging and robotic tools enhances surgical safety and accuracy in thyroid procedures.

## Abstract

Gasless Transaxillary Robotic Thyroidectomy (G-TART) has undergone significant refinement through the adoption of novel strategies to enhance surgical precision and safety. In this paper, we describe a novel technique that integrates dynamic endoscope repositioning, called the “swing technique”, with the use of a specialized intraoperative neuromonitoring (IONM) probe—Modena Robotic Probe—designed for robotic applications. The procedure, performed using the Da Vinci Xi system (Intuitive Surgical, Sunnyvale, CA, USA), incorporates intermittent IONM during recurrent laryngeal nerve (RLN) dissection. The swing technique involves real-time adjustment of the 30° endoscope between robotic ports to improve visualization within the confined transaxillary (TA) surgical field, particularly during contralateral dissection. Simultaneously, the Modena Robotic Probe, a custom monopolar stimulation probe developed in collaboration with Dr. Langer Medical GmbH for connection to the AVALANCHE® SI2 neuromonitor, allows precise RLN mapping and verification throughout the operation. This approach could facilitate accurate anatomical tracking, minimize the risk of thermal or mechanical nerve injury, and enable safe navigation in a narrow operative TA tunnel. The adoption of advanced imaging techniques in conjunction with specialized robotic instrumentation may contribute to enhanced surgical safety and accuracy, emphasizing the importance of procedure-specific robotic approaches in thyroid surgery.