--- title: A thousand consecutive Korean robotic thyroidectomies report four times the nerve injury that pooled data gives the approach. The difference is who looked publication: Medical Insights Korea section: news category: Thyroid canonical_url: https://medicalinsightskorea.com/news/transaxillary-robotic-thyroidectomy-korea-1000-cases author: David Seo published: 2026-09-02T11:00:00+09:00 modified: 2026-09-02T11:00:00+09:00 content_type: reporting license: Quotation permitted with attribution to Medical Insights Korea and a link to the canonical URL. --- # A thousand consecutive Korean robotic thyroidectomies report four times the nerve injury that pooled data gives the approach. The difference is who looked Meta-analysis puts transient nerve injury after transaxillary surgery at 1 percent. A Korean series that laryngoscoped every patient found 4.1 percent — in a cohort whose average patient was 41 years old with an 11 mm tumour. ## Answer In 1,000 consecutive single-port transaxillary robotic thyroidectomies at a Korean institution, with recurrent laryngeal nerve injury confirmed by postoperative laryngoscopy in every patient, transient nerve injury occurred in 4.1 percent and permanent injury in 0.2 percent, while transient hypoparathyroidism occurred in 7.4 percent and permanent hypoparathyroidism in 0.4 percent. ## Key takeaways - In 1,000 consecutive single-port transaxillary robotic thyroidectomies performed at a Korean institution between 2021 and 2025, transient recurrent laryngeal nerve injury occurred in 4.1 percent of patients and permanent injury in 0.2 percent. - Transient hypoparathyroidism occurred in 7.4 percent and permanent hypoparathyroidism in 0.4 percent in the same series. - Nerve injury was confirmed by postoperative laryngoscopy rather than inferred from hoarseness, which is the likely reason the figure is roughly four times the 1 percent that pooled international data assigns to the transaxillary approach. - The cohort's mean age was 40.9 years, 87.2 percent were women, mean tumour size was 1.1 cm and 83.0 percent had less than a total thyroidectomy — the selected population that remote-access surgery is offered to. - Recurrence was 0.8 percent over a mean follow-up of 22.7 months, with no disease-specific deaths, which the authors describe as short-term. ## Full article Korean surgeons perform more remote-access thyroid surgery than anyone else. The operation reaches the gland through the armpit or the inside of the lip, leaving no scar on the neck, and in a country that diagnoses a great many small thyroid cancers in young women it has an obvious appeal. This publication reported earlier today that the pooled international figure for transient nerve injury after the transaxillary approach — 1 percent — describes who was selected for the operation rather than what the operation does to the nerve. A single-institution Korean series of a thousand consecutive cases now allows that claim to be tested against Korean practice. ### The Korean numbers Surgeons at the Catholic University of Korea reviewed 1,000 consecutive single-port transaxillary robotic thyroidectomies performed between 2021 and 2025, classifying hypoparathyroidism as transient up to twelve months and permanent beyond it, and confirming nerve injury by postoperative laryngoscopy. **Complications in 1,000 consecutive single-port transaxillary robotic thyroidectomies** | Complication | Transient | Permanent | | --- | --- | --- | | Recurrent laryngeal nerve injury | 4.1% | 0.2% | | Hypoparathyroidism | 7.4% | 0.4% | **4.1% vs 1%** — transient nerve injury in a Korean transaxillary series where every patient was laryngoscoped, against the pooled international figure for the same approach _Source: Park J et al., Surgical Endoscopy, 2026_ Mean operative time was 79.1 minutes. Recurrence over a mean follow-up of 22.7 months was 0.8 percent with no disease-specific deaths, a result the authors themselves label short-term. ### Why the gap is a measurement gap A transient vocal cord palsy is only counted if somebody looks for it. A unit that performs laryngoscopy on every patient after surgery finds palsies in people whose voices sound normal to them and to the surgeon. A unit that investigates only patients who complain of hoarseness records a fraction of the same events. > **The same operation, two different numbers** > Nothing here suggests the pooled 1 percent was calculated wrongly or that this Korean unit injures more nerves than others. The likeliest explanation is that this series measured a complication the pooled studies largely did not look for. Between a figure produced by systematic examination and one produced by patient complaint, the higher number is the more honest description of what happens. ### The cohort also proves the selection point Who had these operations is described precisely, and it is exactly the population that makes cross-approach comparisons unsafe. - Mean age 40.9 years. - 87.2 percent women. - Mean tumour size 1.1 cm. - Less than a total thyroidectomy in 83.0 percent; total thyroidectomy in 8.9 percent. - Malignant on final pathology in 85.1 percent, of which papillary carcinoma accounted for 98.2 percent. A cohort of forty-year-old women with 11 mm papillary cancers having one lobe removed is not comparable to an unselected series of thyroid operations, however it is analysed. That is not a criticism of the study, which does not claim otherwise. It is a caution about the comparison the numbers invite. In the less-than-total group, larger tumours and gross extension beyond the thyroid were independently associated with nerve injury. In the group having total thyroidectomy, completion surgery or modified radical neck dissection, no independent risk factor for hypoparathyroidism was identified. ### The other route in A retrospective study across four high-volume centres compared the two transoral techniques in 2,144 patients operated on between 2017 and 2024: 546 by the endoscopic vestibular approach and 1,598 robotically. Total thyroidectomy accounted for 9.6 percent and unilateral lobectomy or isthmectomy for 82.8 percent — again, mostly limited operations. Robotic operations took substantially longer, a mean of 167.5 minutes against 121.3. The authors conclude that both are safe and oncologically sound in appropriately selected patients, that the robotic approach offers lower rates of nerve injury and hypoparathyroidism and may suit more complex cases, and that the endoscopic approach remains an effective scarless option for benign and low-risk disease. The qualifier in that conclusion — appropriately selected — is doing the same work as it does everywhere else in this literature. ### What is still missing 1. The transaxillary series is one institution and one team. High-volume single-centre results are not what a patient elsewhere should expect, in either direction. 2. A mean follow-up of 22.7 months cannot establish oncologic outcomes for a cancer whose recurrences appear over decades. The authors say so. 3. There is still no randomised comparison of remote-access against conventional thyroidectomy, so nothing here can attribute a complication rate to an approach rather than to the patients who receive it. 4. The four-centre transoral study's complication figures were not available to us beyond the authors' summary conclusion, so this article reports that conclusion and does not quantify the difference it describes. 5. Cosmetic outcome, which is the reason most of these operations are chosen, is not measured by any figure in this article. ## Sources - Park J, An S, Bae JS, Kim K. Perioperative and oncologic outcomes of 1,000 consecutive single-port transaxillary robotic thyroidectomy (SP-TART). Surgical Endoscopy 2026. doi:10.1007/s00464-026-13193-7. PMID:42527738. https://doi.org/10.1007/s00464-026-13193-7 - Teoh KH, Oh MY, Lee JH, San Jeon Y, Kim K, Chai YJ, Kim HY. Comparative outcomes of robotic and endoscopic transoral thyroidectomy in a 2,144-patient multicenter cohort. Surgery 2026;197:110343. doi:10.1016/j.surg.2026.110343. PMID:42330608. https://doi.org/10.1016/j.surg.2026.110343 - Awawda R, Merchavy S, Elhadi UA, Safia A. Prevalence and determinants of recurrent laryngeal nerve injury after thyroidectomy: a Systematic Review and meta-analysis. Frontiers in Endocrinology 2026;17:1764332. doi:10.3389/fendo.2026.1764332. PMID:42137353. https://doi.org/10.3389/fendo.2026.1764332 ## Citation David Seo (2026). "A thousand consecutive Korean robotic thyroidectomies report four times the nerve injury that pooled data gives the approach. The difference is who looked". Medical Insights Korea. https://medicalinsightskorea.com/news/transaxillary-robotic-thyroidectomy-korea-1000-cases Retrieved from https://medicalinsightskorea.com/news/transaxillary-robotic-thyroidectomy-korea-1000-cases