LAUSR

Today endoscopic thyroidectomy (ET) has changed thyroid surgery (1). Let’s take for example the ET first propose and applied by Miccoli, i.e., the minimally invasive video-assisted thyroidectomy (MIVAT) (1,2). ET is gold standard when opting for an indeterminate small thyroid nodule, ET is preferred for the cosmetic outcomes and MIVAT is comparable to open surgery for T1 thyroid tumors (1-4). Transoral thyroidectomy (TT) is rapidly evolving, gained popularity as a thyroidal alternative for endocrine endoscopic procedures (5-10). There is a groin feeling that TT may replace other endoscopic procedures both remote and neck access (11-18). Although TT is an expanding new surgery, studies are confined by few Institutions (19-24). A study group for TT has been established in 2016 to optimize standards (21). We read with interest the paper by Chan “Transoral thyroidectomy with a next generation flexible robotic system: a feasibility study in a cadaveric model” published on Gland Surgery (25). Robotic thyroidectomy may be the evolutionary formula of ET (Figure 1). The robotic system allows the endocrine surgeon to continuously articulate all the movements of the human hand and wrist within the neck patient and provides the surgeon with a stereoscopic vision obtained thanks to the use of a video-two-channel optical endoscope and dual 3CCD high resolution camera (11-14). This realtime magnification system allows the surgeon to have a remarkable image quality compared to traditional surgery (11-14). The system provides more than a thousand images per second and the processor filters every single image eliminating background noise (11-14). It also allows scaling of the instruments and the filtering of the trembling of the surgeon’s hands. The movement activation module allows an accurate and fluid movement of the instrumentation on the operating theater (11-14). Preliminary scientific papers testify to the advantages of robotic TT compared to traditional surgery and endoscopic TT (11-14). An important advantage is a better removal of central compartment lymph nodes (for oncological procedures) (11-14). The introduction of robotic platform in combination with single port technology is promising and may overcome limits of standard endoscopic TT (25). The single port TT is a project that was born in the wake of needs that may appear minimal, but which is prodigal of large developments (Table 1). This single access is used as an alternative to the 3–4 usual accesses necessary for transoral surgical intervention with the robot or the endoscope, for interventions on both benign and malignant thyroid disease. The introduction of the optics, the operating and Editorial