{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T06:12:18Z","timestamp":1770963138516,"version":"3.50.1"},"reference-count":15,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T00:00:00Z","timestamp":1770595200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Gasless Transaxillary Robotic Thyroidectomy (G-TART) has undergone significant refinement through the adoption of novel strategies to enhance surgical precision and safety. In this paper, we describe a novel technique that integrates dynamic endoscope repositioning, called the \u201cswing technique\u201d, with the use of a specialized intraoperative neuromonitoring (IONM) probe\u2014Modena Robotic Probe\u2014designed for robotic applications. The procedure, performed using the Da Vinci Xi system (Intuitive Surgical, Sunnyvale, CA, USA), incorporates intermittent IONM during recurrent laryngeal nerve (RLN) dissection. The swing technique involves real-time adjustment of the 30\u00b0 endoscope between robotic ports to improve visualization within the confined transaxillary (TA) surgical field, particularly during contralateral dissection. Simultaneously, the Modena Robotic Probe, a custom monopolar stimulation probe developed in collaboration with Dr. Langer Medical GmbH for connection to the AVALANCHE\u00ae SI2 neuromonitor, allows precise RLN mapping and verification throughout the operation. This approach could facilitate accurate anatomical tracking, minimize the risk of thermal or mechanical nerve injury, and enable safe navigation in a narrow operative TA tunnel. The adoption of advanced imaging techniques in conjunction with specialized robotic instrumentation may contribute to enhanced surgical safety and accuracy, emphasizing the importance of procedure-specific robotic approaches in thyroid surgery.<\/jats:p>","DOI":"10.3390\/jcm15041372","type":"journal-article","created":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T18:02:01Z","timestamp":1770660121000},"page":"1372","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Transaxillary Robotic Thyroidectomy: A Novel Technique and Update"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-3023-1012","authenticated-orcid":false,"given":"Barbara","family":"Mullineris","sequence":"first","affiliation":[{"name":"Department of General, Emergency Surgery and New Technologies, Baggiovara General Hospital Azienda Ospedaliero Universitaria di Modena, Via Pietro Giardini 1355, 41126 Modena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alice","family":"Francescato","sequence":"additional","affiliation":[{"name":"Department of General, Emergency Surgery and New Technologies, Baggiovara General Hospital Azienda Ospedaliero Universitaria di Modena, Via Pietro Giardini 1355, 41126 Modena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giovanni","family":"Colli","sequence":"additional","affiliation":[{"name":"Department of General, Emergency Surgery and New Technologies, Baggiovara General Hospital Azienda Ospedaliero Universitaria di Modena, Via Pietro Giardini 1355, 41126 Modena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Davide","family":"Gozzo","sequence":"additional","affiliation":[{"name":"Department of General, Emergency Surgery and New Technologies, Baggiovara General Hospital Azienda Ospedaliero Universitaria di Modena, Via Pietro Giardini 1355, 41126 Modena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Silvia","family":"Traficante","sequence":"additional","affiliation":[{"name":"Department of General, Emergency Surgery and New Technologies, Baggiovara General Hospital Azienda Ospedaliero Universitaria di Modena, Via Pietro Giardini 1355, 41126 Modena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0930-6770","authenticated-orcid":false,"given":"Micaela","family":"Piccoli","sequence":"additional","affiliation":[{"name":"Department of General, Emergency Surgery and New Technologies, Baggiovara General Hospital Azienda Ospedaliero Universitaria di Modena, Via Pietro Giardini 1355, 41126 Modena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2399","DOI":"10.1007\/s00464-009-0366-x","article-title":"Robot-Assisted Endoscopic Surgery for Thyroid Cancer: Experience with the First 100 Patients","volume":"23","author":"Kang","year":"2009","journal-title":"Surg. Endosc."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e2021.00032","DOI":"10.4293\/JSLS.2021.00032","article-title":"Robot-Assisted Thyroidectomy Versus Open Thyroidectomy in the Treatment of Well Differentiated Thyroid Carcinoma","volume":"25","author":"Pavlidis","year":"2021","journal-title":"JSLS"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1097\/JS9.0000000000000819","article-title":"Surgical Methods of Total Thyroidectomy for Differentiated Thyroid Cancer: A Systematic Review and Bayesian Network Meta-Analysis","volume":"110","author":"Yuan","year":"2023","journal-title":"Int. J. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1089\/lap.2019.0021","article-title":"Evolution Strategies in Transaxillary Robotic Thyroidectomy: Considerations on the First 449 Cases Performed","volume":"29","author":"Piccoli","year":"2019","journal-title":"J. Laparoendosc. Adv. Surg. Tech."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Spinoglio, G. (2015). Transaxillary Thyroidectomy and Parathyroidectomy. Robotic Surgery. Updates in Surgery, Springer.","DOI":"10.1007\/978-88-470-5714-2"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"De Vries, L.H., Aykan, D., Lodewijk, L., Damen, J.A.A., Borel Rinkes, I.H.M., and Vriens, M.R. (2021). Outcomes of Minimally Invasive Thyroid Surgery\u2014A Systematic Review and Meta-Analysis. Front. Endocrinol., 12.","DOI":"10.3389\/fendo.2021.719397"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2470","DOI":"10.1002\/lary.30645","article-title":"Efficacy and Safety of Minimally Invasive Thyroid Surgery: A Network Meta-Analysis","volume":"133","author":"Kim","year":"2023","journal-title":"Laryngoscope"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Papini, P., De Palma, A., Ginesini, M., Rossi, L., Fregoli, L., Elisei, R., Matrone, A., Morganti, R., Ambrosini, C.E., and Materazzi, G. (2023). Robot-assisted Transaxillary Surgery for Thyroid Cancer: Oncologic and Surgical Outcomes in Long Term Follow-up. Robot. Comput. Surg., e2563.","DOI":"10.1002\/rcs.2563"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e24370","DOI":"10.1097\/MD.0000000000024370","article-title":"Detailed Comparison of the Da Vinci Xi and S Surgical Systems for Transaxillary Thyroidectomy","volume":"100","author":"Yu","year":"2021","journal-title":"Medicine"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"74","DOI":"10.21037\/gs-24-409","article-title":"The Evolution and Clinical Impact of Single-Port Transaxillary Robotic Thyroidectomy: A Comprehensive Review","volume":"14","author":"Kim","year":"2025","journal-title":"Gland. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1089\/thy.2015.0020","article-title":"2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer","volume":"26","author":"Haugen","year":"2016","journal-title":"Thyroid"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"S127","DOI":"10.1016\/j.jviscsurg.2023.04.006","article-title":"Robotic Thyroidectomy. Recommendations of the AFCE (Association Francophone de Chirurgie Endocrinienne) with the SFE (Soci\u00e9t\u00e9 Fran\u00e7aise d\u2019endocrinologie) and the SFMN (Soci\u00e9t\u00e9 Fran\u00e7aise de M\u00e9decine Nucl\u00e9aire)","volume":"160","author":"Marciniak","year":"2023","journal-title":"J. Visc. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1393","DOI":"10.1007\/s13304-023-01522-7","article-title":"Management of Surgical Diseases of Thyroid Gland Indications of the United Italian Society of Endocrine Surgery (SIUEC)","volume":"75","author":"Polistena","year":"2023","journal-title":"Updates Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"7555","DOI":"10.1038\/s41598-024-57163-2","article-title":"Expansion of Thyroid Surgical Territory through 10,000 Cases under the Da Vinci Robotic Knife","volume":"14","author":"Kim","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"105941","DOI":"10.1016\/j.ijsu.2021.105941","article-title":"Surgical Outcomes of Different Approaches in Robotic Assisted Thyroidectomy for Thyroid Cancer: A Systematic Review and Bayesian Network Meta-Analysis","volume":"89","author":"Xing","year":"2021","journal-title":"Int. J. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/4\/1372\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T05:20:38Z","timestamp":1770960038000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/4\/1372"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,9]]},"references-count":15,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["jcm15041372"],"URL":"https:\/\/doi.org\/10.3390\/jcm15041372","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,9]]}}}