The Specific Role of Minimally Invasive Robotic Endocrine Surgery

Robotic-assisted transaxillary surgery of the thyroid and parathyroid may overcome some of the limitations of the endoscopic approach. Although the robotic system proved to have several advantages, its widespread use is still controversial due to technical and economic issues. Nevertheless, robotic thyroidectomy and parathyroidectomy proved to be safe and feasible, but should be performed in high-volume centers and in selected patients. High-volume centers have an advantage over low-volume ones, in terms of surgical outcomes and costs containment, since the learning curve is reported to be around 35–40 procedures, which is nonetheless shorter than that of the endoscopic approach. Robotic surgery is reported to offer several advantages over standard laparoscopy also with reference to minimally invasive adrenalectomy. Robotic adrenalectomy is associated with a shorter learning curve, less intraoperative blood loss, shorter length of hospital stay, and an easier approach to large tumors; the main criticism remains cost-effectiveness. Number of cases per year is reported to have a positive influence on both costs and postoperative morbidity, so that robotic adrenalectomy should be implemented in high-volume centers, with experience in both robotic and endocrine surgery. The threshold defining high-volume surgeons is believed to be six procedures per year.