Postoperative Pain Evaluation after Robotic Transaxillary Thyroidectomy vs. Conventional Thyroidectomy: a prospective study.

Background: Robotic Assisted Transaxillary Thyroidectomy (RATT) is an emerging technique with excellent cosmetic result, but supposedly more invasive and painful than Conventional Thyroidectomy (CT). This prospective study aims to compare pain after RATT and CT. Methods: Inclusion criteria were: nodule < 5 cm, volume < 30 ml. Patients received same analgesia. Pain was evaluated by Visual Analogue Scale (VAS) in the recovery room (VASrr), on the first postoperative day (VAS 8am and VAS 8pm), on the second postop day (VAS 8am*) and after 7 days (VAS 7). Operative time (OT) and complications were evaluated. Results: From May 2014 to September 2014, 124 patients underwent thyroidectomy. They were all females. 62 underwent RATT, 62 CT. Mean age was 39.7±10.2 years in RATT group and 41.4±12.5 years in CT group. Groups were comparable for thyroid volume and nodule diameter. OT resulted longer in RATT group than CT group (119,4±25,5 vs 70,3±11,0). Complications were 3 transient hypocalcemia in RATT and 4 in CT group. No definitive complications occurred. VASrr resulted lower in RATT group (1.79±2.06 vs 2.5±1.18) (P<0,0001). There was no difference between groups for VAS 8am, VAS 8pm, VAS 8*am, while VAS 7 resulted higher in RATT group (0.85±1.77 vs 0.17±0.52) (P 0,010). Discussion: RATT resulted safe and effective as CT. Patients undergoing RATT surprisingly experienced less pain in the immediate postoperative period. In contradiction, VAS 7 score was higher in RATT group, probably because intact neck is favorable in early phase, but large dissection takes longer for healing.