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While thyroid stimulating hormone receptor antibody (TRAb) level is associated with disease severity and thyroid vascularity, its impact on operative outcomes remains unclear. This study aimed to compare challenging factors for robotic thyroidectomy (RT) and open thyroidectomy (OT) in Graves\u2019 disease patients, including TRAb as a predictive factor for difficult thyroidectomy. This retrospective study included Graves\u2019 disease patients who underwent total thyroidectomy between September 2013 and January 2023. The clinical characteristics and operative outcomes were compared between patients who received OT and bilateral axillo-breast approach RT. Factors affecting operation time and estimated blood loss (EBL) were evaluated in both groups using regression analyses. A total of 85 patients received either OT (n\u2009=\u200948) or RT (n\u2009=\u200937). Median thyroid volumes in the OT and RT groups were 72.4\u00a0g and 57.6\u00a0g, respectively. Operation time was affected by thyroid volume in both groups. Additionally, higher thyroid hormone levels and bilateral central neck node dissection prolonged operation time in the RT group. EBL was marginally associated with thyroid volume in the OT group. However, in the RT group, TRAb level was independently associated with greater EBL (p\u2009=\u20090.04), while no significant association was found with thyroid volume. Predictive factors for difficult thyroidectomy differed by operation approaches. TRAb significantly predicted intraoperative bleeding in RT, while this association was absent in OT. Caution is warranted when performing RT on Graves\u2019 disease patients with high TRAb levels.<\/jats:p>","DOI":"10.1007\/s11701-024-01869-y","type":"journal-article","created":{"date-parts":[[2024,3,4]],"date-time":"2024-03-04T08:02:52Z","timestamp":1709539372000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["TSH receptor antibody as a predictor of difficult robotic thyroidectomy in patients with Graves\u2019 disease"],"prefix":"10.1007","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5820-3001","authenticated-orcid":false,"given":"Ja Kyung","family":"Lee","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-1159-7895","authenticated-orcid":false,"given":"Yoon","family":"Kong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-5912-8371","authenticated-orcid":false,"given":"Jae Bong","family":"Choi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0615-0563","authenticated-orcid":false,"given":"Woochul","family":"Kim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7338-5157","authenticated-orcid":false,"given":"Hyeong Won","family":"Yu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5511-3596","authenticated-orcid":false,"given":"Su-jin","family":"Kim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8830-3433","authenticated-orcid":false,"given":"Young Jun","family":"Chai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9990-607X","authenticated-orcid":false,"given":"June Young","family":"Choi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2354-3599","authenticated-orcid":false,"given":"Kyu Eun","family":"Lee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2024,3,4]]},"reference":[{"key":"1869_CR1","doi-asserted-by":"publisher","first-page":"216","DOI":"10.1016\/j.surg.2007.07.036","volume":"143","author":"Y Erbil","year":"2008","unstructured":"Erbil Y, Giri\u015f M, Salmashoglu A et al (2008) The effect of anti-thyroid drug treatment duration on thyroid gland microvessel density and intraoperative blood loss in patients with Graves\u2019 disease. 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The authors have no relevant financial or non-financial interests to disclose.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}],"article-number":"108"}}