At the grand stage of ARIS 2025, held in the iconic Ramoji Film City, Apollo Hospitals Hyderabad showcased a landmark moment in minimally invasive endocrine surgery. A live demonstration of a neck scarless robotic thyroidectomy using the RABBAT approach was performed by Dr. Jagdishwar Goud Gajagowni and Dr. Vikas
This technique, which stands for Robotic Axillo-Bilateral Breast Approach for Thyroidectomy (RABBAT), is a step forward in combining oncological safety with unparalleled cosmetic outcomes.
Why RABBAT?
Traditionally, thyroid surgery—whether for benign nodules or malignant cancers—leaves a visible scar on the neck. While the outcomes are often excellent in terms of disease control, the cosmetic impact can be a source of concern, especially for younger patients. The RABBAT approach eliminates this problem by completely avoiding any incision on the neck, yet still allowing for safe and effective thyroidectomy or even neck dissection when needed.
Key Technical Innovations
Over time, our team has refined the technique to make it more ergonomic and precise:
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- Arms by the Side: Unlike earlier versions where patients’ arms were abducted, our method keeps the arms comfortably by the side, making it easier to position and safer for the patient.
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- Tip-Up Grasper: This specialized instrument provides better control while holding the thyroid gland, allowing for steady and delicate dissection.
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- EndoWrist Scissors Only: By relying on the robotic scissors alone, we fully leverage the EndoWrist’s 7 degrees of freedom, offering unmatched dexterity to navigate around the recurrent laryngeal nerve and critical vessels.
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- Full Use of 3D Camera: A major strength of this approach is the enhanced visual access it provides. We can visualize straight ahead, underneath or between vessels, and from the sides—something nearly impossible with conventional open or laparoscopic techniques.
For the Patient – A Delighted Recovery
While this technique is technically demanding and may challenge even seasoned robotic surgeons, the results are incredibly rewarding for patients. They walk away without a scar on their neck, recover faster, and carry no visible sign of surgery—a huge psychological and cosmetic win.
We recommend that surgeons complete at least 50 robotic surgeries before embarking on thyroid cases. Mastery of instrument handling, patient positioning, and robotic console control is essential to ensure patient safety and surgical success.
From Experience to Excellence
Our journey began with the trans-axillary and transoral approaches, but we found them less reproducible and harder to adapt across different patient profiles. That led us to innovate and standardize the RABBAT technique, making it both scalable and teachable. This isn’t just about surgery. It’s about building a movement—a mission to teach 19 young surgeons who will each train another 10, creating a ripple effect of robotic excellence that will spread across India and beyond
