Objective:To evaluate the feasibility, safety, and oncological adequacy of robot-assisted thyroid surgery via the bilateral axillo-breast approach (BABA) in obese patients.Methods:Clinical data of 112 obese patients with thyroid carcinoma who underwent surgical treatment at the First Ward of General Surgery, the First Medical Center of Chinese PLA General Hospital, between January 1 and December 31, 2024, were retrospectively collected. Among them, 44 patients underwent robot-assisted surgery (robotic group) and 68 patients underwent conventional open surgery (open group) . Both groups were stratified by extent of surgery (unilateral/bilateral) , degree of obesity (mild/moderate-severe) , and sex (male/female) . Operative time, intraoperative blood loss, postoperative length of hospital stay, postoperative parathyroid function, and the number of lymph nodes harvested were compared between the two groups, group comparisons were conducted using the Mann-Whitney U test and the χ 2 test; interaction analyses were performed using generalized linear models and Firth-corrected logistic regression. Results:All procedures were completed successfully. In unilateral thyroidectomy, the robotic group demonstrated significantly less intraoperative blood loss compared with the open group (15.0 mL vs. 20.0 mL, P= 0.019) , while no significant differences were observed in postoperative length of hospital stay, rate of parathyroid hormone (PTH) decline, lymph node-related parameters, or complication rates. However, the robotic group had a significantly longer operative time (85.0 min vs. 70.0 min) , higher hospitalization costs (64,000 CNY vs. 22,000 CNY) , and greater mean daily postoperative drainage volume (46.3 mL vs. 31.7 mL) (all P < 0.05) . In bilateral thyroidectomy, no significant difference in mean daily postoperative drainage volume was observed between the two groups ( P=0.034) , while the trends of the remaining indicators were consistent with those in the unilateral subgroup. In the subgroup with mild obesity, the rate of PTH decline was lower in the robot group than in the open group (46.9% vs. 61.7%, P=0.022) .In the female subgroup, the postoperative mean daily drainage volume was higher in the robotic group than in the open group (38.3 mL vs. 30.0 mL, P=0.011) . Conclusion:Robot-assisted thyroid surgery via the bilateral axillo-breast approach is safe and feasible in obese patients. Obesity does not significantly increase the perioperative risks or postoperative complications associated with robotic thyroidectomy. For patients with cosmetic concerns, the robotic approach offers superior scar concealment.
(8.0+极速模式)