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The intuitive da Vinci single port surgical system and feasibility of transoral thyroidectomy vestibular approach

Remote-access thyroid surgery is increasingly implemented to reduce the morbidity of an anterior cervical incision resulting from traditional thyroid surgery. While most remote-access approaches leave a cutaneous scar, the recent development of the transoral vestibular approach (TOVA) enables the achievement of a truly scarless surgery, as all incisions are made in the oral vestibule. Unfortunately, the adoption of the robotic system in transoral thyroid surgery has been limited by the need for an additional axillary incision, prohibitive cost, and steep learning curve of robotic surgery. The Intuitive da Vinci single port (SP) robotic surgical system (Intuitive Surgical, Inc., Sunnyvale, CA, USA), introduced in 2018, may enable transoral robotic thyroid surgery without an axillary port. Additionally, the new SP system is equipped with two “joggle joints” in the robotic arms and endoscope, allowing for additional flexibility in a narrow workspace. Compared to previous generations, the SP robot offers a greater range of motion and more precise surgical control, a derivative of fully articulating instruments on a similar console like the Xi system. This review provides an overview of literature on the application of the intuitive da Vinci SP robotic surgical system via the TOVA in thyroid surgery.