Defining the role for robotics in endocrine surgery – benefits and challenges

Robotic surgery has become an integral tool in many surgical specialties and may soon become the standard for minimally invasive surgery.Despite the lack of clear level 1 evidence supporting robotic surgery as the first line approach, and the associated costs, there is significant evidence reporting on the perceived benefits of robotics including three-dimensional vision, stable platform and increased precision. 1The benefits to the patients include shorter length of stay, less blood loss, and fewer complications; with surgeon reported benefits of less musculoskeletal injury providing further support for the role of robotic surgery.These findings are consistent across many surgical specialties. 2,3 n the United Kingdom, compared to the exponential adoption in other surgical specialties, the uptake of robotics in endocrine surgery is poor.Endocrine surgery was one of the first surgical specialties to embrace minimally invasive surgery with the first laparoscopic adrenalectomy performed by Michel Gagner over 30 years ago. 4In his early experience, Gagner reported that patients experienced less postoperative pain and quicker return to normal activities.More recently, minimally invasive approaches have been described for thyroid surgery.These approaches performed either through the axilla or through the mouth have similar outcomes compared to traditional thyroid surgery without the cosmetic issues of a scar on the neck.With robotic surgery supplanting laparoscopy in most surgical specialties, what is the role for robotics in endocrine surgery?