Robotic Bilateral Total Thyroidectomy Using the Double Bipolar Method with the da Vinci SP System: A Propensity Score-Matched Comparison with the Xi System

Background/Objectives: The da Vinci SP system offers a single-port configuration with flexible, multijointed instruments, but evidence comparing it with the Xi system in robotic bilateral total thyroidectomy (BTT) remains limited. This study compared surgical outcomes and postoperative complications between the two platforms. Methods: We retrospectively reviewed 548 consecutive patients with thyroid cancer who underwent robotic BTT by a single surgeon between 2010 and 2024. Patients were analyzed separately according to central compartment neck dissection (CCND) or modified radical neck dissection (MRND). Propensity score matching was performed at a 1:1 ratio based on age, sex, body mass index, and tumor size. Serial calcium and parathyroid hormone (PTH) levels were additionally examined in matched patients who developed transient hypocalcemia. Results: The overall cohort included 396 patients in the Xi group and 152 in the SP group. Overall complications (34.3% vs. 21.7%, p = 0.003) and transient hypocalcemia (28.3% vs. 14.5%, p = 0.001) were less frequent in the SP group. Propensity score matching yielded 70 pairs in the CCND cohort and 47 pairs in the MRND cohort. In the matched CCND cohort, the SP group had lower rates of overall complications (18.6% vs. 40.0%, p = 0.024) and transient hypocalcemia (10.0% vs. 30.0%, p = 0.013). Complication rates did not differ significantly between the platforms in the matched MRND cohort. Surgical and pathological outcomes were generally comparable. Among patients with transient hypocalcemia, the decline in calcium at 6 months was smaller in the SP group in the CCND cohort (p = 0.013), whereas the MRND cohort showed smaller declines in PTH at selected postoperative time points but no significant between-group differences in calcium changes. Conclusion: Robotic BTT using the da Vinci SP system and the Double Bipolar Method was safe and feasible. Compared with the Xi system, this approach achieved generally comparable surgical and pathological outcomes and was associated with fewer postoperative complications in the matched CCND cohort.