To explore the method of nerve protection in da Vinci robotic thyroid surgery through oral vestibular approach.

The clinical data of 70 patients who underwent transoral da Vinci robotic thyroidectomy in the Department of Thyroid and Breast Surgery of 960th Hospital of PLA from May 2020 to Nov.2021 were retrospectively analysis, including 8 males and 62 females. The age ranged from 15 to 55 years old, with an average age of (31.59±9.65) years. Among them, there were 12 benign patients and 58 malignant patients. In all patients, the method of refined capsule dissection combined with intraoperative nerve monitoring was used to dissect the recurrent laryngeal nerve and avoid the superior laryngeal nerve, protect the function of the mental nerve and the marginal mandibular branch of facial nerve by avoiding the area where they run. The clinical data of thyroid tumor patients were collected and the neurological function related to surgery was evaluated. SPSS 23.0 software was used for statistical analysis.

In this study, all operations were successfully completed with none transferred to open surgery. Among all the cases, 1 case(1.4%) had a skewed corner of the mouth due to the marginal mandibular branch of facial nerve injury, 1 case(1.4%) had temporary recurrent laryngeal nerve palsy, and there was no mental nerve, superior laryngeal nerve and permanent recurrent laryngeal nerve injury.

In robotic thyroid surgery through oral vestibular approach, refined capsule anatomy combined with intraoperative nerve monitoring anatomy to expose the recurrent laryngeal nerve and avoid the superior laryngeal nerve can effectively protect the function of the laryngeal nerve, and avoiding the mental nerve and marginal mandibular branch of facial nerve can reduce the risk of associated nerve injury.