remoteaccess thyroidectomy a multiinstitutional north american experience with transaxillary robotic facelift and transoral endoscopic vestibular approaches background many remoteaccess approaches raas to the thyroid have been described to circumvent anterior neck scarring including the transaxillary robotic facelift and transoral endoscopic vestibular approaches these techniques have been popularized in asia but adoption has been slow in north america we aimed to examine multiinstitutional north american outcomes with raa thyroidectomy in the context of these institutions transcervical approach tca outcomesstudy design cases of lobectomy and total thyroidectomy via transaxillary robotic facelift and transoral endoscopic vestibular approaches were reviewed demographic characteristics outcomes and complications were compared with the same measures in patients undergoing lobectomy and total thyroidectomy via tca by the primary raa surgeons at each institution patients who underwent parathyroidectomy or other concomitant neck dissection procedures were excludedresults two hundred and sixteen raa thyroidectomies were attempted 92 transoral endoscopic vestibular approaches 70 transaxillary and 54 robotic facelift and 410 tca thyroidectomies were performed there was no difference in mean index nodule sizes between raa 28 16 cm and tca 29 19 cm cohorts p 072 median operative times for lobectomy were 146 minutes range 60 to 343 minutes and 90 minutes range 25 to 247 minutes for the raa and tca cohorts respectively p 00001 median operative time for total thyroidectomy was 170 minutes range 100 to 398 minutes vs 1265 minutes range 51 to 260 minutes for the raa and tca cohorts respectively p 00001 there was no difference in the rates of permanent recurrent laryngeal nerve injury between the raa 0 of 216 0 and tca 0 of 410 0 cohorts p 099conclusions remoteaccess approach thyroidectomy can be performed in a select north american patient population with outcomes comparable with tca