We would like to thank Kandil et al for taking the time to comment on our case report. We support their call for a judicious and safe approach to preventing neuromuscular complications by use of robotic-assisted transaxillary surgery.
To that end, it was our conscious decision not to proceed with total thyroidectomy through a unilateral single incision. We do not feel that a unilateral approach is appropriate for our patient population. We have personally observed Dr Chung's procedure and have reviewed his data, which were provided to us by Dr Ryu and others. We recognize that the experience described is that of the Korean population. This population, in general, has a much smaller body mass index and body habitus than that of our American cohort. In our patients, we feel that adequate reflection of the contralateral lobe and safe exposure of the contralateral recurrent laryngeal nerve are not possible through a unilateral incision. We are concerned that the contralateral resection will not adequately remove all the thyroid tissue. As such, it would not be an ideal approach for either malignancy or treatment of hyperthyroidism. For those who pursue total thyroidectomy, we suggest the use of postoperative radioactive uptake scans, ultrasonographic examination, and videostroboscopy, to ensure and document the removal of all thyroid tissue, and postoperative monitoring of the recurrent laryngeal nerve.