Robotic Selective Neck Dissection Using a Gasless Postauricular Facelift Approach for Early Head and Neck Cancer: Technical Feasibility and Safety

Abstract

Preliminary results indicate that robotic selective neck dissection via a gasless postauricular facelift approach is feasible and safe and allows for excellent postoperative cosmesis. Further studies are necessary to determine the oncologic safety and surgical completeness of this procedure compared with conventional neck dissection.

Robot-assisted level II-IV neck dissection through a modified facelift incision: initial North American experience

“…Oncological control and staging is of paramount importance and should not be overshadowed by improved cosmesis. The number of lymph nodes retrieved was not statistically significantly different between the patients undergoing robot‐assisted neck dissection and those with similar disease undergoing conventional, open‐neck dissection (33.3 LN in RAND vs 24.8 LN in conventional ND), similar to previous reports, which demonstrated oncological effectiveness in four patients undergoing RAND compared to traditional open lymphadenectomy . Our lymph node dissections are not typically broken down by level in pathology reporting; however, in the two RAND specimens which were broken down, LN yield was an average of 14.5 from level II, nine from level III and 13.5 from level IV, which we believe indicates adequacy at the distal aspect of our dissection.…”

“…Our operative times were overall longer than the reported times for the RAND in that study, which we feel is largely due to the difference in their reporting of operative time (incision to removal of specimen) and learning curve, rather than any differences in operative technique. In either case, we would anticipate that the gap in operative (5,17). Our lymph node dissections are not typically broken down by level in pathology reporting; however, in the two RAND specimens which were broken down, LN yield was an average of 14.5 from level II, nine from level III and 13.5 from level IV, which we believe indicates adequacy at the distal aspect of our dissection.…”

Robotic Selective Neck Dissection by a Postauricular Facelift Approach: Comparison with Conventional Neck Dissection

“…[13][14][15][16] Currently a facelift approach with or without preauricular incision is being used for parotidectomy, excision of the submandibular gland and benign neck masses, and thyroid lobectomy, with or without the assistance of endoscope or Otolaryngology-Head and Neck Surgery 150 (3) surgical robot. 7,9,17 We have expanded the postauricular facelift approach with the assistance of the da Vinci robot for selective neck dissection including levels I-III or levels II-V. 16 The robotic system provides a 3-dimensional magnified view and permits precise and multi-articulated motion, and it is especially appropriate when fine manipulation of tissues in a deep and narrow operative field is needed, as in head and neck surgery. 18 In this study, the surgical outcomes of robotassisted neck dissection via a postauricular facelift approach were similar to those of conventional neck dissection.…”

Postoperative immune response and surgical stress in selective neck dissection: Comparison between endoscopically assisted dissection and open techniques in cT1-2N0 oral squamous cell carcinoma

“…Laparoscopic rectectomies (Kvarnstrom et al, 2013), colectomies (Tsamis et al, 2012;Veenhof et al, 2012;Wang et al, 2012), and prostatectomies (Narita et al, 2013) are superior to open operations with respect to reducing the amount of intraoperative bleeding and relieving post-operative pain, thereby reducing the surgical stress reaction, improving pulmonary function, promoting post-operative rehabilitation, and decreasing the postoperative length of the hospital stay. Over the past 20 years, advancements in endoscopic and robot-assisted procedures have allowed alternative, smaller, or even complete avoidance of neck incisions in OSCC selective neck dissection (SND) (Kim et al, 2012;Lee et al, 2012;Tae et al, 2013;Byeon et al, 2014). These surgeries for SND are actually more invasive than traditional direct open neck approaches but produce desirable neck cosmesis at the cost of more soft tissue dissection, increased postoperative pain, and longer operative times (Kim et al, 2012;Lee et al, 2012;Tae et al, 2013).…”

“…Over the past 20 years, advancements in endoscopic and robot-assisted procedures have allowed alternative, smaller, or even complete avoidance of neck incisions in OSCC selective neck dissection (SND) (Kim et al, 2012;Lee et al, 2012;Tae et al, 2013;Byeon et al, 2014). These surgeries for SND are actually more invasive than traditional direct open neck approaches but produce desirable neck cosmesis at the cost of more soft tissue dissection, increased postoperative pain, and longer operative times (Kim et al, 2012;Lee et al, 2012;Tae et al, 2013). Recently, aiming to strike a balance between scarless surgery and minimal invasiveness, we first performed endoscopically assisted SND via a small submandibular approach, with satisfactory cosmetic results and minimal invasiveness, for patients with cT1-2N0 OSCC (Fan et al, 2014).…”