Abstract Background The Single-Port Robotic Areolar (SPRA) approach is a recently developed technique using the da-Vinci SP, offering excellent cosmetic results and easy access to both thyroid and lateral neck nodes. This study presents a single-surgeon experience of more than 400 SPRA cases. Methods A retrospective review was conducted on 412 consecutive SPRA surgeries performed over three years. Procedures included 320 lobectomies, 69 total thyroidectomies, 7 completion thyroidectomies, and 16 modified radical neck dissections (MRND). Pathology showed papillary thyroid carcinoma (PTC) in 370 patients (89.8%). Results All procedures were completed without conversion. Mean operative times were 86.2 ± 18.7 min for lobectomy, 114.3 ± 23.3 min for total thyroidectomy, and 201.8 ± 50.9 min for MRND. Lymph node retrieval averaged 4.98 ± 4.11 nodes for central neck dissection and 29.31 ± 12.60 nodes for MRND. Vocal cord palsy occurred in 2 transient (0.5%) and 1 permanent (0.2%). Hypoparathyroidism occurred in 14 transient (3.4%) and 2 permanent (0.5%) with PTH 16.07 ± 10.08 pg/mL in postoperative 2-days and 22.09 ± 10.75 pg/mL in 3-months after surgery. Postoperative 3-month Tg averaged 1.65 ± 4.15 ng/mL, with 79.2% of patients showing Tg ≤ 1 ng/mL. No postoperative recurrence occurred. Conclusion This largest number of SPRA reports demonstrates that it is a safe, versatile technique performed with the da-Vinci SP system. The expansion from conventional thyroidectomy to completion thyroidectomy and MRND confirms its utility across all domains of thyroid cancer surgery, including re-do operations and lateral neck metastasis, with strong functional and oncologic outcomes. Trial registration ClinicalTrial.gov NCT07138820
J Wook Yi (Fri,) studied this question.