Ichiro Tateya

OBJECTIVE: To evaluate the safety and feasibility of transaxillary robotic thyroidectomy (TART) in Japan by comparing early cases with video-assisted neck surgery (VANS). METHODS: Single-center retrospective review of 31 consecutive thyroid lobectomies: 16 VANS (Nov 2020-Feb 2025) and 15 TART (Mar 2022-Feb 2025). TART used da Vinci Surgical system (da Vinci) Xi for early cases and predominantly da Vinci SP thereafter. Indications included differentiated cancer ≤4 cm, cN0, unilateral disease without extrathyroidal invasion, or follicular tumors 3-5 cm. Operative time, blood loss, hospital stay, complications, and cosmetic outcomes were evaluated and compared with statistical analysis. RESULTS: All procedures were completed without conversion to open surgery. Blood loss (16.5 g vs 25.8 g) and length of stay (6.3 vs 6.1 days) were comparable. Complications included two transient recurrent laryngeal nerve palsies after VANS and, after TART, one axillary bleed controlled under local anesthesia and one lymphatic leak; overall rates were similar. High cosmetic satisfaction was reported in both cohorts. CONCLUSION: Early experience shows TART is feasible and safe in Japan, achieving perioperative outcomes comparable to VANS with excellent cosmetic results.

Patients with neurodegenerative diseases and children with severe mental and physical disabilities are often managed with tracheostomy tubes due to repeated aspiration pneumonia. Longterm tracheostomy tube placement increases the risk of complications and requires frequent sputum suctions by caregivers, making institutionalization and the introduction of home care difficult. Surgical closure of the larynx is a useful technique that can avoid pneumonia, decrease the frequency of sputum suctions, and provide relief from airway management by tracheostomy tube. We investigated the usefulness and safety of 18 cases of surgical closure of the larynx by removal of cricoid cartilage (Kano's method) performed at our department over a 7-year period from April 2015 to March 2022. Except for one patient with unknown postoperative course, cannula withdrawal was possible in 6 of 6 (100%) patients using tubes who were not on respiratory management, and postoperative complications were limited to one case of fistula formation at the glottis closure site. In addition, 3 of 5 patients who were preoperatively unable to take orally were able to ingest orally postoperatively, and one patient was on alternative nutrition but was able to take oral intake. A survey of caregivers showed a decrease in the frequency of sputum suctions in most cases, and 75% of them expressed satisfaction with the results of the surgery. As a result, we believe this technique is useful and safe for patients with repeated severe aspiration pneumonia in terms of airway management without a tracheostomy tube.