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General Surgery
Robotic Total Thyroidectomy via Bilateral Axillo-Breast Approach (BABA)
Built from Atlas of Thyroid Surgery
What’s inside
5 sections · 41 slides
Overview
What BABA is, why it is used, and how the technique developed
- What BABA robotic thyroidectomy is
- Advantages of the BABA approach
- How BABA developed
- The case presented
Technique
Positioning, ports, docking, and the thyroid removal itself
- BABA operation sequence
- Positioning and nerve monitoring
- Patient positioning for BABA
- Incisions and flap creation
- Subplatysmal flap with midline exposure
- Roles of the BABA ports
- Robot docking and instruments
- Robot arm docking and spacing
- Dividing the midline and isthmus
- Anterior neck exposure during BABA
- Parathyroid and nerve localization
- Inferior parathyroid exposure
- Inferior parathyroid and recurrent laryngeal nerve
- Recurrent laryngeal nerve and ligament of Berry
- Superior parathyroid dissection
- Superior pole and contralateral lobe
- Contralateral lobe removal and instrument swap
- Clipping the superior-pole vessels
Neck Dissection
Central neck clearance followed by the right modified radical neck dissection
- Central neck dissection
- Anteromedial central neck lymph nodes
- Central neck lymph node dissection
- Extending the flap to expose sternocleidomastoid
- Right modified radical neck dissection exposure
- Sternocleidomastoid retraction
- Sternocleidomastoid lateral retraction
- Carotid, jugular, and vagus dissection
- Carotid, jugular, and vagus dissection
- Carotid artery and internal jugular vein dissection
- Jugular and prevertebral lymph nodes
- Spinal accessory nerve localization
- Spinal accessory nerve preservation
- Lateral neck level 2 and 3 dissection
Closure and Specimen
Finishing the operation and removing the specimen
- Closure and specimen removal
- Closure of strap muscles
Summary
Key points to take from the chapter
- Takeaways
- References
- Atlas of Thyroid Surgery