Bilateral axillo-breast approach robotic thyroidectomy (BABA-RT) versus transoral robotic thyroidectomy (TORT): a systematic review and meta-analysis

The aim of this study is to conduct a systematic review and meta-analysis of all comparative studies that evaluated the surgical outcomes between bilateral axillo-breast approach-robotic thyroidectomy (BABA-RT) and transoral robotic thyroidectomy (TORT). The Cochrane Central Register of Controlled Trials, PubMed, Scopus, and Web of Science databases were screened until July 2022. The Risk of Bias in Non-Randomized Studies for Interventions (ROBINS-I) tool was used to evaluate study quality. The data were summarized as mean difference (MD) or risk ratio (RR) with 95% confidence interval (CI) in a fixed-effects or random-effects model. Five comparative observational studies met the inclusion criteria comprising 923 patients (TORT = 408 and BABA-RT = 515). The study quality varied and included low (n = 4) and moderate (n = 1) risk of bias. There was no significant difference between both groups regarding the mean operative time (MD = 19.98 min, 95% CI [−11.33, 51.28], p = 0.21), mean hospital stay (MD = −0.14 days, 95% CI [−0.66, 0.38], p = 0.60), mean number of retrieved lymph nodes (MD = 0.42, 95% CI [−0.16, 0.99], p = 0.16), and rate of recurrent laryngeal nerve injury (RR = 0.39, 95% CI [0.13, 1.19], p = 0.10). However, the TORT group had significantly reduced mean postoperative pain score (MD = −0.39, 95% CI [−0.51, −0.26], p < 0.001) and lower rate of hypocalcemia (RR = 0.08, 95% CI [0.02, 0.26], p < 0.001) than the BABA-RT group. TORT and BABA-RT have comparable surgical outcomes. Both methods are largely safe and effective when patients are carefully chosen. However, TORT appears to offer better results regarding postoperative pain and hypocalcemia. Further clinical trials with extended follow-up periods are needed to confirm our findings.