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We evaluated the feasibility of a novel Single-incision, via a Midline Approach, Robotic Transaxillary Thyroidectomy (SMART-T), which combines the cosmetic advantages of a concealed axillary incision with the bilateral midline exposure provided by the bilateral axillo-breast approach (BABA). A prospective analysis was performed on an initial series of patients who underwent SMART-T between June and July 2026. Demographic, operative, pathological, and postoperative data were collected. Sixteen patients successfully underwent SMART-T without conversion. All patients underwent lobo-isthmusectomy (11 right-sided and 5 left-sided procedures). Mean operative time was 99.6\u2009\u00b1\u200917.5 min, with mean docking and console times of 5.1\u2009\u00b1\u20092.0 and 55.6\u2009\u00b1\u200917.7 min, respectively. Ipsilateral central neck dissection was completed in three patients. One patient experienced transient minimal vocal cord hypomobility that resolved within 7 days. No other complication occurred. Postoperative pain and analgesic requirements were minimal. Subjective voice and swallowing impairment were minimal and completely recovered by postoperative day 7. Cosmetic outcomes were rated as excellent by 87.5% of patients. The present study reports the first European clinical series of SP BABA-derived thyroid procedures. SMART-T is a feasible single-port robotic approach to thyroidectomy that provides a BABA-like midline operative view through a single axillary incision, with encouraging early operative, functional, and cosmetic outcomes that support further evaluation in larger studies with longer follow-up.<\/jats:p>","DOI":"10.1007\/s11701-026-03960-y","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T04:30:20Z","timestamp":1789705820000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Single-port, via a midline approach, Robotic Transaxillary Thyroidectomy (SMART-Thyroidectomy): description of the technique and evaluation of feasibility in the first case series"],"prefix":"10.1007","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1259-2491","authenticated-orcid":false,"given":"Marco","family":"Raffaelli","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierpaolo","family":"Gallucci","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilda","family":"Hoxhaj","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Pennestr\u00ec","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,18]]},"reference":[{"issue":"3","key":"3960_CR1","doi-asserted-by":"publisher","first-page":"1876","DOI":"10.1007\/s00464-026-12644-5","volume":"40","author":"YW Chang","year":"2026","unstructured":"Chang YW (2026) Robotic thyroidectomy using the da Vinci SP surgical system. 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Updates Surg 78(3):1021\u20131025. https:\/\/doi.org\/10.1007\/s13304-026-02601-1","journal-title":"Updates Surg"}],"container-title":["Journal of Robotic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11701-026-03960-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11701-026-03960-y","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11701-026-03960-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T04:30:30Z","timestamp":1789705830000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11701-026-03960-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,18]]},"references-count":38,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["3960"],"URL":"https:\/\/doi.org\/10.1007\/s11701-026-03960-y","relation":{},"ISSN":["1863-2491"],"issn-type":[{"value":"1863-2491","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,18]]},"assertion":[{"value":"10 August 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 September 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 September 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was performed in accordance with the principles of the Declaration of Helsinki and was approved by the Comitato Etico Territoriale Lazio Area 3 \u2013 Roma (ID 4999).","order":2,"name":"Ethics","label":"Ethics approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study involved human participants and did not include animal experiments.","order":3,"name":"Ethics","label":"Research involving human participants and\/or animals","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All patients included in this study provided written informed consent at the time of surgery for the use of their clinical data in future research.","order":4,"name":"Ethics","label":"Informed consent","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":5,"name":"Ethics","label":"Consent to publish","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"1001"}}