Modified Facelift Approach Research Articles

Establishing the robotic surgery procedure and techniques for head and neck tumors: a single surgeon's experience of 945 cases.

We suggested operative techniques and indications of robotic neck surgery. To determine operative techniques and the indications for robotic neck surgery, we analyzed treatment outcomes of patients who received robotic neck surgery. Between May 2010 and July 2018, a total of 945 patients with various neck diseases visited Severance Hospital and underwent robotic neck surgery. A variety of approaches, including the retroauricular approach (RA), modified facelift approach (MFLA), transaxillary approach (TA), and transaxillary retroauricular approach (TARA), was used to remove various tumors in the neck. A total of 235 patients underwent a robotic neck dissection (elective or therapeutic) in the treatment of head and neck cancer with metastatic cervical lymph nodes. Five hundred-seventeen patients underwent robotic thyroidectomy or parathyroidectomy for thyroid or parathyroid disease, respectively. The remaining 193 patients underwent robotic neck surgery in the treatment of other neck diseases. Various neck lesions were successfully excised using RA or MFLA (including salivary gland tumors, thyroid tumors, vascular tumors, neurogenic tumors, lipomas, lymphangiomas, venous malformations, dermoid cysts, and others). Robotic neck surgery is a feasible and safe technique for the resection of various head and neck tumors. This method could be particularly useful in young patients with thyroid tumors, salivary gland tumors, and vascular tumors, among others, because it does not leave a visible scar on the face or neck. The superior visualization and articulate robotic arm that moves freely at various angles allows surgeons to perform delicate and precise surgeries.

Modified facelift approach for posterior segmental mandibulectomy: a blend of oncology and cosmesis.

The approach to the mandible for segmental resection in malignant pathologies entails a lip-split, angle-split or visor flap incision with extension of the incision into the neck for performing neck dissection. The modified facelift approach with robot-assisted neck dissection can be used to achieve oncologically safe resections with good cosmesis. Three patients meeting the inclusion criteria underwent the procedure at the Robotic facility of HCG Cancer Centre, Bangalore. The patients were analyzed on the basis of bone defect length, the margin status of primary, functional and aesthetic outcomes. One patient had wound dehiscence and needed secondary suturing. At 6months, patients were satisfied with the aesthetic outcomes and functional results CONCLUSION: Modified facelift approach is a feasible procedure ensuring better cosmesis without compromising oncological outcomes.

Modified facelift approach combined with a superficial musculoaponeurotic system flap in the treatment of benign parotid tumors

The purpose of this study was to investigate the adequacy of a modified facelift incision combined with an SMAS flap for the resection of benign parotid lesions in terms of cosmesis and incidence of Frey's syndrome. A hundred patients who underwent superficial parotidectomy were divided into 2 groups according to approach: Blair incision (57 cases) and modified facelift incision (43 cases). In the latter group, 36 patients were reconstructed with a superficial musculoaponeurotic system (SMAS) flap. During follow-up, patients were asked to rate their satisfaction with their postoperative appearance using a 1 to 3 scale. Clinical Frey's syndrome was present in 8.5% of patients with SMAS flap, and in 19% patients without SMAS flap (p = 0.16). The average cosmetic outcome score for patients who underwent a modified facelift approach combined with an SMAS flap was 2.87, whereas patients whose tumors were approached through a Blair incision reported a lower score of 2.1 (p < 0.005). A modified facelift incision combined with an SMAS flap improved the cosmetic appearance of patients who underwent extrafacial or superficial parotidectomy. In addition, this flap seems to reduce the occurrence of Frey's syndrome.

Endoscopic retroauricular thyroidectomy: preliminary results.

We sought to seek the potential role of endoscopic thyroidectomy with the retroauricular (RA) approach prior to future comparative study with the robotic RA thyroidectomy. Therefore, this study aims to verify the surgical feasibility of endoscopic RA thyroidectomy. Eighteen patients who underwent endoscopic RA thyroidectomy for clinically suspicious papillary thyroid carcinoma or benign lesions from January to December 2013 were retrospectively reviewed and analyzed. All endoscopic operations via RA or modified facelift approach were successfully performed, without any significant intraoperative complications or conversion to open surgery. Based on patient-reported outcome questionnaires, all patients were satisfied with their postoperative surgical scars. Endoscopic RA thyroidectomy is technically feasible and safe with satisfactory cosmetic results for patients where indicated.

Reconstruction of the segmental mandibular defect using a retroauricular or modified face-lift incision with an intraoral approach in head and neck cancer

Conclusions: This is the first report of mandibular reconstruction using the retroauricular (RA) or the modified face-lift (MFL) approach in head and neck cancer. This approach may have advantages over the conventional approach, especially in its superior aesthetic results. Objective: The fibular osseous or osteocutaneous free flap is a widely accepted option for the reconstruction of mandibular defects. Recently, we devised an RA or an MFL approach for neck dissection (ND) using an endoscopic or robotic surgical system. Here, we performed the reconstruction of a segmental mandibular defect with a fibular free flap using the RA or the MFL approach. Methods: A total of five patients underwent mandibular reconstruction with the RA or MFL approach for mandibular discontinuity, which developed after the surgical extirpation of head and neck cancer. We performed ND, segmental mandibulectomy, and the reconstruction of the mandibular defect via RA or MFL incisions. Results: An osseous free flap was used for the reconstruction in two patients and the osteocutaneous free flap was used in three patients. The mean operation times for mandibulectomy and ND were 82 (range 45–120) min and 156 (range 140–180) min, respectively. No significant complications were noted. All flaps survived successfully.

Minimally invasive selective neck dissection: a prospective study of endoscopically assisted dissection via a small submandibular approach in cT(1-2_N(0) oral squamous cell carcinoma.

Selective neck dissection (SND) in clinical N0 (cN0) cases of oral squamous cell carcinoma (SCC) has been performed by surgeons using a retroauricular or modified facelift approach with robotic or endoscopic assistance. However, these procedures provide cosmetic satisfaction at the cost of possible maximal invasiveness. In this prospective study, we introduced and evaluated the feasibility as well as surgical invasiveness and cosmetic outcome of endoscopically-assisted SND via a small submandibular approach. Forty-four patients with cT1-2N0 oral SCC (OSCC) were randomly divided into two groups of endoscopically-assisted SND and conventional SND. Perioperative and postoperative outcomes of patients were evaluated, including the length of the incision, operating time for neck dissection, estimated blood loss during the operation, amount and duration of drainage, total hospitalization period, total number of lymph nodes retrieved, satisfaction scores based on the cosmetic results, perioperative local complications, shoulder syndrome, and follow-up information. The mean operation time in the endoscopically-assisted group (126.04±12.67min) was longer than that in the conventional group (75.67±16.67min). However, the mean length of the incision was 4.33±0.76cm in the endoscopically-assisted SND group, and the amount and duration of drainage, total hospital stay, postoperative shoulder pain score, and cosmetic outcomes were superior in the endoscopically-assisted SND group. Additionally, the retrieved lymph nodes and complications were comparable. Endoscopically-assisted SND via a small submandibular approach had a longer operation time than the conventional approach. However, endoscopically-assisted SND was feasible and reliable while providing minimal invasiveness and satisfactory appearance.

Therapeutic robot‐assisted neck dissection via a retroauricular or modified facelift approach in head and neck cancer: A comparative study with conventional transcervical neck dissection

In a previous study of robot-assisted neck dissection (RAND), we limited the indication for neck dissection in clinical N0 head and neck cancer. The purpose of this study was for us to present the comparison of the results of therapeutic RAND via a retroauricular or modified facelift approach with outcomes from conventional neck dissection in clinical node-positive head and neck cancer. This study involved a total of 53 patients who underwent neck dissection for head and neck cancer. Operative and pathologic parameters were assessed. The RAND and the conventional neck dissection group consisted of 20 and 33 patients, respectively. The mean operative time for the RAND group was significantly longer than that of the conventional neck dissection group. The mean number of retrieved lymph nodes in the RAND group was not significantly different from the conventional neck dissection group. Therapeutic RAND via a retroauricular or modified facelift approach was successful with satisfactory esthetic results in patients with node-positive head and neck cancer.

Robot‐assisted selective neck dissection combined with facelift parotidectomy in parotid cancer

Robot-assisted neck dissection in patients with head and neck cancer has been demonstrated to be feasible. We conceived a surgical technique of surgery for parotid cancer with the robotic system via a gasless modified facelift (MFL) approach. A detailed surgical technique is provided. In a 28-year-old female patient with parotid cancer, the disease was treated with primary tumor resection with robotic selective neck dissection I to III via an MFL incision. Robot-assisted selective neck dissection I to III combined with primary tumor resection was successfully conducted without any significant intraoperative complication, applying additional incision, or conversion to open conventional neck dissection. Videographic demonstration of the robotic-assisted neck dissection is included. Robot-assisted surgery via the MFL approach is a feasible and useful method with excellent cosmetic results for the surgical treatment in selected cases of parotid gland cancer.

Endoscopic supraomohyoid neck dissection via a retroauricular or modified facelift approach: Preliminary results

Based on our previous experiences with endoscopic or robotic neck surgery utilizing the retroauricular (RA) or modified facelift (MFL) approach, we realized the value of verifying the feasibility of endoscopic supraomohyoid neck dissection (SOND). Therefore, the purpose of this study was to evaluate the potential role of endoscopic SOND. Six patients who underwent elective endoscopic SOND of the ipsilateral neck for biopsy proven head and neck cancer from January 2011 to February 2012 were analyzed. All endoscopic operations via RA or MFL were successfully performed without any significant intraoperative complications or conversion to open surgery. Based on patient-reported outcome questionnaires, all patients were satisfied with the cosmetic surgical outcomes. Endoscopic selective neck dissection via an RA or an MFL approach is technically feasible and safe with satisfactory cosmetic results for patients with clinically node-negative early-stage head and neck cancer.

OP191: Robot-assisted modified radical neck dissection via a retroauricular or modified face lift approach in clinically N+ head and neck cancer: A comparative study with the conventional transcervical neck dissection

Purpose In our feasibility study of robot-assisted neck dissection (RAND), we limited the indication for elective neck dissection (ND) in clinical N0 head and neck cancer. With growing experiences of RAND, we saw potential for therapeutic RAND in positive neck without extracapsular spread (ECS). In this study, we aim to compare the results of therapeutic RAND via a retroauricular (RA) or modified face-lift (MFL) approach with conventional transcervical ND in head and neck cancer. Materials and methods This study involved a total of 53 patients who underwent therapeutic ND for head and neck cancer at the department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea, from May 2010 to July 2012. Patients themselves decided whether the RAND or the conventional open ND would be performed for the treatment of neck metastasis with the information of the advantages and the disadvantages of both procedures. The following variables were assessed: age, gender, body mass index, primary site, TNM stage, operative parameters, pathologic parameters, perioperative complications, and satisfaction of scar. Results The RAND group consisted of 17 males and three females, with a median age of 62.5 years. The conventional ND group consisted of 30 males and three females, with a median age of 63.0 years. The mean operation time for ND of the RAND group was longer than that of the conventional ND group (186 ± 37 vs 150 ± 23) (p = 0.000). The mean number of retrieved lymph nodes in the RAND group (41.60 ± 12.47) showed no significant difference from that in the conventional ND group (44.39 ± 14.35) (p = 0.474). There were no significant differences in the development of postoperative complications between the RAND group and the conventional ND group. The score of satisfaction scar was significantly higher in the RAND group than in the conventional ND group (p = 0.023). The median follow-up periods were 8.0 month in the RAND group and 9.3 month in the conventional ND group. Conclusions Therapeutic RAND via a RA or MFL approach was feasible and successful, with satisfactory aesthetic results in patients with N+ head and neck cancer. This RAND technique via a RA or MFL approach may be applied to the selected cases by an experienced surgeon.

OP187: Endoscopic supraomohyoid neck dissection via a retroauricular or modified facelift approach: Preliminary results

Purpose Based on our previous experiences of endoscopic or robotic neck surgery utilizing the retroauricular (RA) or modified facelift (MFL) approach, we realized the necessity of verifying the feasibility of endoscopic supraomohyoid neck dissection (SOND). Therefore this study aims to evaluate the potential role of endoscopic SOND. Materials and methods Six patients who underwent elective endoscopic SOND of the ipsilateral neck for biopsy proven head and neck cancer from January 2011 to February 2012 were analyzed. Results All endoscopic operations via RA or MFL were successfully performed, without any significant intraoperative complications or conversion to open surgery. Based on patient-reported outcome questionnaires, all patients were satisfied with the cosmetic surgical outcomes. Conclusion Endoscopic selective neck dissection via a RA or a MFL approach is technically feasible and safe with satisfactory cosmetic results for patients with clinically node negative early-stage head and neck cancer.

Robotically assisted selective neck dissection in parotid gland cancer

AbstractObjectives/Hypothesis:Robot‐assisted neck dissection (ND) in head and neck cancer patients has been demonstrated to be feasible. We hypothesized that surgery for parotid cancer could be achieved via a gasless modified facelift approach using the robotic system. We intended to evaluate the feasibility of robot‐assisted selective ND (SND) via a modified facelift (MFL) approach in parotid gland cancer.Study Design:Case series.Methods:Primary tumor resection with robotic SND I–III via MFL was performed in five patients with parotid gland cancer.Results:All cases of robot‐assisted SND I–III combined with primary tumor resection were successfully conducted without any significant intraoperative complication, applying additional incision or conversion to open conventional ND. The amount and duration of drainage, hospital stay, retrieved lymph nodes, and complications were generally acceptable. The postoperative scar was able to be completely hidden by the auricle and hair.Conclusions:Robotically assisted surgery via an MFL approach is a feasible and useful method, with excellent cosmetic results for the surgical treatment in selected cases of parotid gland cancer. Laryngoscope, 2013

Robot-Assisted Sistrunk’s Operation, Total Thyroidectomy, and Neck Dissection via a Transaxillary and Retroauricular (TARA) Approach in Papillary Carcinoma Arising in Thyroglossal Duct Cyst and Thyroid Gland

Background Carcinomas arising in the thyroglossal duct cysts are rare, accounting only for about 0.7–1.5 % of all thyroglossal duct cysts.1–3 Synchronous occurrence of thyroglossal duct carcinoma and thyroid carcinoma is reported to be even rarer.4 Traditionally, surgical treatments of such coexisting thyroglossal duct cyst carcinoma (TGDCa) and papillary thyroid carcinoma (PTC) were typically performed through a single transverse or double incisions on the overlying skin. A longer, extended cervical incision might be required if neck dissection is necessary. Though this method provides the operator with the optimal surgical view, the detrimental cosmetic effect on the patient of possessing a scar cannot be avoided, despite the effort of the surgeon to camouflage the scar by placing the incision in natural skin creases. Recently, the authors have previously reported the feasibility of robot-assisted neck dissections via a transaxillary and retroauricular (“TARA”) approach or modified face-lift approach in early head and neck cancers.5,6 On the basis of the forementioned surgical technique, we demonstrate our novel technique for robot-assisted Sistrunk’s operation via retroauricular approach as well as robot-assisted neck dissection with total thyroidectomy via transaxillary approach.

Robotic sialoadenectomy of the submandibular gland via a modified face-lift approach

The purpose of this study was to describe and analyse the advantages and disadvantages of submandibular gland (SMG) resection using a robotic surgical system through a modified face-lift approach. The authors performed robotic sialoadenectomy of the SMG on 5 patients using the daVinci robot system through a modified face-lift approach. Three robotic arms were inserted through a modified face-lift incision; a face-down 30-degree endoscopic arm and two operative arms. The right arm was equipped with a harmonic scalpel and the left arm with a Maryland forceps. In all patients, robotic sialoadenectomy of the SMG was completed successfully. Diagnoses were sialolithiasis in two patients, pleomophic adenoma in two patients, and ranula in one patient. The mean robotic operative time was 90.2min (range 62–185min) and that for setting the robotic system was 8.2min (range 5–15min). No significant intra-operative or postoperative complications were observed. All patients were satisfied with the outcome and especially the cosmetic results at their last follow-up visit. In the authors opinion robotic sialoadenectomy of the SMG is technically feasible and secures a better cosmetic outcome than endoscopic submandibular resection.

Modified face-lift approach combined with a superficially anterior and superior-based sternocleidomastoid muscle flap in total parotidectomy

The authors evaluate a modified total parotidectomy performed through a modified face-lift incision integrated with a superficially anterior and superior pedicled sternocleidomastoid muscle (SASSCM) flap. Records of 86 cases of total parotidectomy were reviewed retrospectively. Clinical evaluation of cosmetic gratification, presence or absence of gustatory flushing or sweating, functional reversion of the seventh cranial nerve and great auricular nerve (GAN) were undertaken by 3 investigators independent to the operators. This group presents a mean follow-up of twenty-six months. The average scale of cosmetic gratification from patients and investigators are 7.97 and 7.56, respectively. Almost total complaints about anesthesia in upper cervical part and cheek disappeared within three months postoperatively. Neither in objective test nor from subjective complaint was gustatory sweating identified in present study. The authors' technique is esthetically pleasing and efficacious to prevention of gustatory sweating in total parotidectomy.

Robot-Assisted Selective Neck Dissection via Modified Face-lift Approach for Early Oral Tongue Cancer: A Video Demonstration

Robot-Assisted Selective Neck Dissection via Modified Face-lift Approach for Early Oral Tongue Cancer: A Video Demonstration