The endoscopic approach to the Neck: A review of the literature, and overview of the various techniques

Abstract

With a good proof of indication gasless lifting techniques, video assisted endoscopical techniques and subcutaneous approaches with gas filling procedures are feasible in neck surgery. All methods depending on the surgeons' experience describe no significantly extended operation times, a better and faster wound-healing and an optimized cosmetic outcome, compared to open approaches. Surgeons should always be aware of the limitations of the minimal invasive techniques regarding the complications or modifications during neck dissection/thyroidectomy.

Robotic-Assisted Neck Dissection Through a Pre- and Post-auricular Hairline Incision: Preclinical Study

“…In a review of different endoscopic approaches to the neck by Muenscher et al, 9 the procedures were not only feasible, but also without major complication; although improved cosmetic outcomes were noted, operative time was prolonged. Terris et al 10 in their work on robotic resection of the submandibular gland in a cadaver model has proven that robotic endoscopic surgery is feasible in that setting.…”

Minimally invasive techniques for head and neck malignancies: current indications, outcomes and future directions

“…Dissection of levels II-V were feasible in a time frame of 183 min (total thyroidectomy + central neck dissection + bilateral video-assisted lateral neck dissections) and 125 min (total thyroidectomy + central neck dissection + right video-assisted lateral neck dissection), respectively, in two reported cases. However, reports of endoscopic lateral neck dissection are generally small case series which show that gasless or insuZation techniques, with or without robotic assistance are feasible and surgically safe for squamous cell carcinoma and diVerentiated thyroid cancer in very experienced hands [92,93]. However, the oncological eYcacy of these techniques remains to be demonstrated, whatever the type of tumor, and this approach remains experimental until more data are accrued.…”

Advanced Developments in Neck Dissection Technique: Perspectives in Minimally Invasive Surgery

“…Although endoscopic operations were initially limited to regions with natural cavities such as the peritoneum and pleura, the use of endoscopic approaches for head and neck surgery has extended their indications to regions without a natural cavity. All validated methods try to reduce the extent of surgical trauma and its associated morbidity (Muenscher et al, 2011). The main reasons for the development of endoscopic neck surgery are the unpredictable risks of unsatisfactory cosmetic results.…”

“…Advantages and disadvantages of various endoscopic techniques. (Muenscher et al, 2011) Furthermore, endoscopic and minimally invasive/video assisted dissections require special instruments and are more costly and time consuming. Although complication rates are low after endoscopic neck surgery, several morbidities, such as injuries to arteries and veins, embolism, subcutaneous emphysema, pneumothorax and pneumomediastinum, were described in early reports on the use of these methods in thyroid surgery.…”

“…Minimally invasive approaches are advantageous for patients with benign neck lesions, thyroid disease, and selective/sentinel lymph node dissections, due to better cosmetic results and shorter wound healing times. Surgeons tend to favor video assisted minimally invasive techniques or endoscopic surgery using a gasless transaxillary approach, creating the working space by retraction, because the gas filling procedures, especially at level IV, bear some risks (Muenscher et al, 2011).…”