Robotic Assisted Thyroidectomy in ENT Surgery: A Modern Perspective on Neck Dissection

Abstract

Robotic assisted thyroidectomy (RAT) has shifted the paradigm of endocrine neck surgery from a scar?centred to a function? and cosmesis?centred discipline. By harnessing three?dimensional high?definition optics, tremor filtration, and multi?articulated instrumentation, RAT permits extracervical access routes that hide scars yet preserve or even enhance lymph?node clearance. This paper reviews current robotic approaches—including trans?axillary, bilateral axillo?breast insufflation (BABA), and transoral vestibular routes—and appraises their application to selective neck dissection. Recent meta?analyses show complication rates comparable with open surgery, with superior patient?reported cosmetic outcomes, albeit at the expense of longer operative times and higher cost. Early Indian experience and global multicentre series demonstrate oncological safety for well?differentiated thyroid carcinoma and feasibility for levels?II–V nodal dissection. Challenges remain: steep learning curves, capital expenditure, evidence gaps in long?term survival, and access inequity between high? and middle?income settings. Future directions include artificial?intelligence?augmented visualisation, haptic feedback, and cost?effective indigenous robotic platforms.

Keywords: Robotic thyroidectomy; Transoral vestibular approach; Bilateral axillo?breast insufflation; Selective neck dissection; Head?and?neck oncology