Objective  To investigate the clinical efficacy and advantages of robotic thyroidectomy (RT) via the bilateral axillo-breast approach (BABA) in the treatment of papillary thyroid carcinoma (PTC).

  Methods  The clinical data of 338 patients with PTC who underwent thyroid surgery in Tianjin Medical University Cancer Institute and Hospital from November 2017 to March 2020 were retrospectively analyzed. In total, 153 patients underwent RT (robotic group), while the remaining patients underwent conventional open thyroidectomy (COT; open group). The learning curve in the robotic group was drawn using the moving average method; the learning curve was divided into the learning stage and platform stage. The differences in surgical efficacy, complication rates, and postoperative cosmetic outcomes of incisions were compared between the robotic group (in the platform period) and the open group.

  Results  The mean age was significantly lower in the robotic group than in the open group (P<0.05). After the completion of 16 RTs, the operation time in the robotic group was significantly shortened and stabilized. The operation time was significantly longer and postoperative drainage volume was significantly higher in the platform period in the robotic group than in the open group (P<0.05). There were no significant differences between the two groups in terms of intraoperative blood loss, postoperative drainage time, postoperative hospital stay, and the number of dissected central lymph nodes and metastatic lymph nodes (P>0.05). Postoperative C-reactive protein (CRP) levels were significantly higher in the robotic group than in the open group (P<0.05). The visual analogue scale score (VAS) for incision pain on the first postoperative day were lower in the robotic group than in the open group (P<0.001). The incidence of recurrent laryngeal nerve injury and hypoparathyroidism was comparable between the two groups (P>0.05). One month after total thyroidectomy, there was no significant difference in thyroglobulin levels between the two groups (P>0.05). The numerical score system (NSS) scores for postoperative esthetics related to the incision were significantly higher in the robotic group than in the open group (P<0.001).

  Conclusions  BABA–RT is safe and feasible for the treatment of PTC. Its surgical effect is equivalent to that of COT, and BABA–RT leads to significantly better postoperative cosmetic outcomes.