Robot-assisted Neck Dissection Research Articles

Evaluation of the safety and effectiveness of robot-assisted neck dissections.

Robot-assisted neck dissection (RAND) for the management of the regional lymphatic basin offers the potential for improved cosmesis and reduced lymphedema. While RAND has been previously described, functional outcome and oncologic control rates need further elucidation. A retrospective, matched cohort study of neck dissections completed at UPMC from 2017 to 2021 was conducted. RAND was identified and matched to open neck dissections (open) in a 1:2 ratio. Matching characteristics included primary cancer site, pre-operative clinical N-stage, age at time of surgery, HPV status, and previous chemoradiation treatment (salvage vs. nonsalvage procedure). Additional information was collected on patient demographics, surgery characteristics, and outcomes. Comparisons were made using t-test, chi-square test, Fisher's exact test, and Kaplan-Meier Wilcoxon (KMW) test with p < 0.05 indicating significance. Overall, RAND and open groups had similar distributions of age, gender, BMI, primary site of cancer, HPV status, clinical N-stage, clinical T-stage, known neck disease prior to procedure, prior chemoradiation therapy, and level(s) of neck dissection. Surgically, RAND procedures yielded less drainage on average (124 mL in RAND vs. 220 mL in open approaches; p = 0.01). There was no difference in the rates of complications, estimated blood loss, or number of lymph nodes obtained. There were also no differences in the rates of adjuvant therapy. Long term, there were no differences in the rates of local, locoregional, and distant recurrence of primary disease between RAND and open procedures. There were also no differences in postprocedure disease-free survival time (KMW p-value = 0.32; HR [of RAND compared with open] = 0.62). Similarly, there were no statistical differences in the overall survival of RAND patients when compared with the open group (75 vs. 58.9 months; HR = 0.11, p = 0.87). This study is the first to report the long-term effectiveness of robot-assisted surgery compared with the traditional, open approach. In addition to well-known cosmetic benefits, robot-assisted surgery may also offer patients a reduction in uncomfortable drains and improved effects from lymphedema. Overall, this study provides initial data that the RAND may be considered as an alternative approach to open surgery.

ASO Visual Abstract: Comparing Free-Flap Reconstruction After Robot-Assisted Neck Dissection via the Retroauricular Approach and Traditional Transcervical Approach: Single-Surgeon Experiences of 90 Consecutive Cases.

ASO Visual Abstract: Comparing Free-Flap Reconstruction After Robot-Assisted Neck Dissection via the Retroauricular Approach and Traditional Transcervical Approach: Single-Surgeon Experiences of 90 Consecutive Cases.

Robotic infraclavicular approach for minimally invasive neck dissection in head-neck cancers.

In the recent years, there has been a rapid increase in the use of robot assisted neck dissection (RAND) as an alternative method for conventional neck dissection. Several recent reports have emphasized upon the feasibility and effectiveness of this technique. However, substantial technical and technological innovation is still essential in spite of the availability of multiple approaches for RAND. The present study describes a novel technique, i.e., Robotic Infraclavicular Approach for Minimally Invasive Neck Dissection (RIA MIND) used in head and neck cancers with the help of Intuitive da Vinci Xi Surgical System. After RIA MIND procedure, the patient was discharged on the third post operative day. Also, the total wound size was less than 3.5 cm which enhanced the patient recovery time and required minimal post operative care. The patient was further reviewed 10 days after the procedure for the removal of sutures. RIA MIND technique was effective and safe for performing neck dissection for oral, head and neck cancers. However, additional detailed studies will be required for establishing this technique.

ASO Author Reflections: Single Surgeon Experiences of Free-Flap Reconstruction After Robot-Assisted Neck Dissection via the Retroauricular Approach: 90 Consecutive Cases.

ASO Author Reflections: Single Surgeon Experiences of Free-Flap Reconstruction After Robot-Assisted Neck Dissection via the Retroauricular Approach: 90 Consecutive Cases.

Comparing Free-Flap Reconstruction After Robot-Assisted Neck Dissection via a Retroauricular Approach and a Traditional Transcervical Approach: Single-Surgeon Experiences of 90 Consecutive Cases.

Predominant traditional approaches for most patients who have advanced-stage oral cancer with transcervical incision lines left irreversible scars. To address this, surgeons have continuously refined minimally invasive surgery (MIS) techniques, including robot-assisted neck surgeries. This article introduces and discusses the feasibility, versatility, and availability of free-flap reconstruction via the retroauricular approach (RA), considered difficult to date. This study retrospectively analyzed 90 consecutive patients who had free-flap reconstruction performed by a single surgeon (D.K.) in the Department of Oral and Maxillofacial Surgery, Yonsei University, from March 2021 to April 2022. The type of defects and flaps, hospitalization days, total operation time, and type of vessels and anastomoses were compared statistically. The type of vessels used did not differ between the RA and the transcervical approach (TA) groups, nor in duration of hospital stays. Likewise, the total reconstruction time did not differ significantly between the TA group (240min) and the RA group (245 min) (p = 0.756). However, the total operation time was about 1h less in the TA group, a statistically significant difference (TA group [593 ± 152min] vs. RA group [655 ± 117min]; p = 0.044). All flaps were successful in the RA group, whereas one flap in the TA group led to a total loss (TA group [98.3%] vs. RA group [100.0%]; p = 1.000). Even for patients with advanced oral cancer who require massive tumor ablation, it is feasible to obtain an aesthetic and functional surgical outcome by performing free-flap reconstruction via the retroauricular approach.

Robot-Assisted Total Thyroidectomy with or without Robot-Assisted Neck Dissection in Pediatric Patients with Differentiated Thyroid Cancer.

Pediatric thyroid cancer more frequently develops cervical node metastasis than adult thyroid cancer, even in differentiated thyroid carcinoma (DTC). Thus, cervical neck dissection often needs to be performed simultaneously with thyroidectomy in pediatric patients. Herein, we describe our experience with robot-assisted total thyroidectomy with/without robot-assisted neck dissection in pediatric patients compared with the conventional operated group. A total of 30 pediatric patients who underwent thyroidectomy for DTC between July 2011 and December 2019 were retrospectively reviewed. Among them, 22 underwent robot-assisted operation, whereas 8 underwent conventional operation. There was no statistical difference in the mean operation times, blood loss, drainage amounts, and hospital stay length between the robot-assisted and conventional operation groups; however, the operation time was less in the retroauricular approach subgroup (robot-assisted operation group) with better satisfaction on cosmesis. No postoperative complications, such as seromas, hemorrhages, or hematomas were observed. Our experience suggested that robot-assisted thyroidectomy with or without neck dissection through the retroauricular approach is a feasible and safe alternative treatment, producing outstanding esthetic results compared to the conventional approach, especially in pediatric patients with DTC.

Role of Robotics in Non-oropharyngeal Head and Neck Tumours.

Transoral robotic surgery has been gaining widespread acceptance for the treatment of oropharyngeal malignancies. It has shown tremendous growth in the field of non-oropharyngeal malignancies like thyroidectomy, neck dissection, and parapharyngeal tumours. Many studies have aimed at studying the safety and efficacy of the technique. The literature is abundant for procedures and treatment protocols for oropharyngeal malignancy; however, there is paucity on its usability in non-oropharyngeal malignancy. We aim to review the literature to analyse the usability of robotics in non-oropharyngeal tumours and study the evolution and future applications of robotics in head and neck cancer. A thorough literature search using keywords "Transoral robotic surgery", "TORS", " Robotics in Head and Neck", " Robot-assisted Neck Dissection", " Robotic Thyroidectomy", " Robotic Laryngectomy", " Robotics in salivary gland disease", " Parapharyngeal space", "Systematic review", and "Meta-analysis" was done. The articles were reviewed individually by each author for a dedicated sub-heading. A narrative review was formulated under the subheadings-thyroid surgery, salivary gland, neck dissection, parapharyngeal space, and laryngectomy. The role of robotics has expanded with the advances in technology. Non-oropharyngeal head and neck disease can be approached using robotics. Careful patient selection provides a significant advantage of function and cosmesis and helps in avoiding inadvertent complications. With our growing experience, we might see a surge in robot-assisted head and neck surgery.

Robot-assisted neck dissection

The neck dissection is an integral component of comprehensive oncologic care for patients with head and neck cancer. Modern robotic surgical platforms are being utilized within otolaryngology for a growing number of indications, including, robot-assisted neck dissections. The proposed benefits of robot-assisted include improved cosmesis and reductions in post-operative lymphedema. Early data suggests that oncologic control following robot-assisted neck dissection is comparable to the gold-standard, open technique. Here we present review of the surgical techniques involved in a robot-assisted neck dissection as well as a review of perioperative care.

Robot-assisted Neck Dissection in Head and Neck Malignancy: a Study Conducted at a Tertiary Care Cancer Center

Robot-assisted Neck Dissection in Head and Neck Malignancy: a Study Conducted at a Tertiary Care Cancer Center

Robot-assisted real-time sentinel lymph node mapping in oral cavity cancer: preliminary experience.

This study aims to assess the feasibility of using indocyanine green and robotic near infra-red fluorescent imaging (Firefly®) for sentinel lymph node biopsy in cN0 oral cavity cancer. Ten patients with early squamous cell carcinoma of the tongue (n = 8) and buccal mucosa (n = 2) were included. Peritumoral injection of 10mg indocyanine green and real-time mapping of sentinel lymph nodes in the neck was performed using Firefly® via a retro-auricular trans-hairline incision. Sentinel lymph node was detected in all patients at 1.2 sentinel lymph node per person. Majority were situated in level II (91.7%). Mean time to detection of sentinel lymph node was 171.0 (68.0-312.0)s. Mean signal-to-background ratio was 5.62 (3.51-7.91). Frozen section of one sentinel lymph node was positive for malignancy, paraffin section of which confirmed the presence of metastatic disease. Modified radical neck dissection was performed for that particular patient, paraffin section of which did not show any tumor deposit. Frozen section and paraffin section of all other sentinel lymph nodes (n = 11) and neck dissection specimens yielded no malignancy. All resection margins were clear. Three patients completed adjuvant radiotherapy for pT2N0 (n = 2) and pT2N1 (n = 1) carcinoma of the tongue. Mean follow-up was 12.0 (4.0-18.0) months. All patients were alive at last follow-up with no disease recurrence. There were no adverse outcomes associated with the use of indocyanine green and robot-assisted neck dissection. Indocyanine green and Firefly® for sentinel lymph node biopsy in cN0 oral cavity cancer is feasible with no adverse effects.

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.

Minimally invasive neck dissection: A 3-year retrospective experience of 45 cases.

Objective:Robot-assisted neck dissection requires a larger wound, is expensive and requires specialised equipment which is not easily available. We have developed an inexpensive minimally invasive neck dissection (MIND) procedure using simple endoscopic instruments in the past. This study was conducted to evaluate the safety, efficacy and reproducibility of the technique.Materials and Methods:From January 2013 to December 2016, we performed MIND on 45 patients with oral cancer using the standard endoscopic equipment. CO2 gas insufflation was used to create the working space. Intra-operative data, post-operative data and pathological characteristics were evaluated and overall survival (OS) and disease-free survival (DFS) Kaplan–Meier curves were compared using the Log-Rank test.Results:Median operative time was 130 (80–190) min with a mean blood loss of 63 (20–150) ml. Major intra-operative complications were not observed. The median number of nodes retrieved was 14 (range: 7–38). Three patients with a positive lymph node were advised to undergo adjuvant radiotherapy. After consultation, 12 out of 13 tongue cancer patients with a tumour depth >3 mm underwent adjuvant radiotherapy. Mean follow-up period was 31.5 (95% confidence interval [CI] 27.9–35.1) months and 27.8 (95% CI 23.6–32.1) months for OS and DFS, respectively. Four (8.9%) deaths and 8 (17.8%) recurrences were observed. The 3-year OS and DFS was 91.1% and 82.2%, respectively.Conclusion:MIND is aesthetically better than conventional procedures for oral cancer patients due to its safety, efficacy and reproducibility at any centre using the standard laparoscopic equipment.

Functional and cosmetic outcomes of robot-assisted neck dissection by a postauricular facelift approach for head and neck cancer

ObjectivesThe purpose of this study was to compare the functional and cosmetic outcomes of robot-assisted neck dissection with those of conventional neck dissection. Materials and methodsWe prospectively analyzed 113 patients with head and neck cancer who underwent unilateral neck dissection by a robot-assisted postauricular facelift approach (38 patients) or conventional trans-cervical approach (75 patients). Postoperative functional outcomes such as edema, sensory loss, pain, and fibrosis in the neck, and limitations of neck and shoulder motion, and cosmetic satisfaction scored by questionnaire were evaluated serially up to 1year postoperatively, and compared between the two groups. ResultsThere were differences at baseline clinicopathologic characteristics including age, T classification and stage between the two groups. The mean score of neck edema was lower in the robotic group than that of the conventional group at 1day and 3days postoperatively, and sensory loss was also lower in the robotic group at 1day, 3days and 1week postoperatively (P<0.05). The postoperative cosmetic satisfaction were significantly higher in the robotic group than the conventional group at 1month, 3, 6, and 12months postoperatively. Transient marginal nerve palsy was higher in the robotic group than the conventional group (P=0.043). ConclusionPostoperative neck edema and sensory loss were lower in the robotic group in the early postoperative period although its clinical significance is not clear. Cosmetic satisfaction was superior in the robotic group.

Robot-Assisted Neck Dissection Through a Modified Facelift Incision.

The aim of this study is to describe the feasibility as well as oncologic outcomes of robot-assisted neck dissection (RAND) through a modified facelift incision in an American population. Retrospective case series. University tertiary care hospital. All patients who underwent RAND between November 2012 and December 2014 were included. Medical records were reviewed for demographics, medical histories, staging, operative information, postoperative hospital course and complications, and oncologic outcomes. There were 11 RANDs identified among 10 patients. Five patients had known nodal metastasis at the time of surgery. Two patients had been previously irradiated. The average time of surgery was 284.4 ± 72.3 minutes, including other associated procedures. The average lymph node yield was 28.5 ± 9.3 nodes. There were no major complications. Average follow-up was 19.4 months. There was 1 supraclavicular recurrence in a previously irradiated patient. All patients are currently alive and without evidence of disease. Robot-assisted neck dissection is a safe and feasible procedure that can be performed by surgeons with familiarity with neck dissection and robot-assisted surgery and who have been trained in RAND. Appropriate oncologic outcomes can be obtained in a patient wishing to avoid a noticeable scar.

Learning curve for robot-assisted neck dissection in head and neck cancer: a 3-year prospective case study and analysis.

Robot-assisted neck dissection (RAND) for the management of regional metastases is a recently developed technique in the field of head and neck cancer that uses a robotic surgical system. This is the first report that estimates the learning curve for RAND. To evaluate a learning curve for RAND according to the types of neck dissection and report clinical outcomes. Prospective case study of 90 patients undergoing neck dissection between May 2010 and April 2013 at a university tertiary referral center. Fifty modified radical neck dissections (MRNDs) and 40 supraomohyoid neck dissections (SONDs) were performed by a single surgeon using a robotic surgical system to treat head and neck cancer. The MRND and the SOND groups were subdivided into 5 and 4 consecutive subgroups of 10 patients each, respectively. Perioperative parameters were compared, including mean operation time, duration and amount of drainage, length of hospital stay, and postoperative complications. Significant decreases in mean operation time were observed as experience performing RAND increased in both the MRND and the SOND groups. The mean operation time for the MRND group decreased by 29% over the course of our study (initial subgroup, 298.1 minutes; last subgroup, 212.4 minutes). The mean operation time for the SOND group decreased by 53% over the course of our study (initial subgroup, 226.5 minutes; last subgroup, 106.1 minutes). There were no significant differences between subgroups for the other perioperative parameters. We explored the RAND learning curve in a single institution over a 3-year period. This study can be used as a timeline reference for institutions where the RAND procedure will be adopted as an alternative procedure.

Feasibility of robot-assisted neck dissection followed by transoral robotic surgery

Our aim was to evaluate the feasibility of robot-assisted neck dissection (RAND) followed by transoral robotic surgery (TORS) in treatment of cancers of the head and neck, which is expected to improve cosmesis and function. We studied 37 patients with biopsy-confirmed cNO or cN+ tumours of the oropharynx (n=22), hypopharynx (n=8), larynx (n=6), and oral cavity (n=1) who were treated by RAND then TORS from May 2010 to December 2012. Patients’ characteristics and clinical details were recorded, together with operative complications and functional variables such as management of the airway and nasogastric or enterogastric feeding. All endoscopic TORS and RAND were successful, with no serious intraoperative complications or need to convert to open operation. All patients were satisfied with the cosmesis according to the answers given to a questionnaire. RAND followed by TORS in some cancers of the head and neck are feasible and showed a clear cosmetic benefit, although the longer operating time is a drawback. Studies of more patients with longer follow-up are required to evaluate long-term oncological and functional outcomes in more detail.

Robotic total thyroidectomy with modified radical neck dissection via unilateral retroauricular approach.

Background Traditionally, total thyroidectomy was performed through an open transcervical incision; in cases where there was evident nodal metastasis, the conventional surgical approach was to extend the incision into a large single transverse incision to complete the required neck dissection. However, recent innovation in the surgical technique of thyroidectomy has offered the opportunity to reduce the patient’s burden from these prominent surgical scars in the neck. Minimally invasive surgical techniques have been developed and applied by many institutions worldwide, and more recently, various techniques of remote access surgery have been suggested and actively applied.1, 2, 3, 4, 5, 6 Since the advent of robotic surgical systems, some have adopted the concept of remote access surgery into developing various robotic thyroidectomy techniques. The more former and widely acknowledged robotic thyroidectomy technique uses a transaxillary (TA) approach, which has been developed by Chung et al. in Korea.7,8 This particular technique has some limitations in the sense that accessing the lymph nodes of the central compartment is troublesome. Terris et al. realized some shortcomings of robotic TA thyroidectomy, especially in their patients in the United States, and developed and reported the feasibility of robotic facelift thyroidectomy.9, 10, 11, 12, 13 In cases of thyroid carcinomas with lateral neck node metastases, most abandoned the concept of minimally invasive or remote access surgery and safely adopted conventional open surgical methods to remove the tumor burden. However, Chung et al. have attempted to perform concomitant modified radical neck dissection (MRND) after robotic thyroidectomy through the same TA port.14 This type of robot-assisted neck dissection (RAND) had some inherent limitations, due to fact that lymph nodes of the upper neck were difficult to remove. Over the past few years, we have developed a RAND via modified facelift (MFL) or retroauricular (RA) approach and reported the feasibility and safety of this technique.15, 16 Since then, we have actively applied such RAND techniques in various head and neck cancers. In our country, almost all cases of robotic total thyroidectomy utilize the TA approach. According to the reports made by Terris et al., robotic facelift thyroidectomy technique has been solely applied for ipsilateral hemithyroidectomy. For total thyroidectomy, Terris et al. performed the robotic surgery with bilateral RA incisions. Here, we intend to introduce our novel surgical method after successfully attempting simultaneous robotic total thyroidectomy and RAND via a single RA approach without an axillary incision. To our knowledge, this is the first to report in the medical literature.

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

Cosmesis is of increasing importance to the otolaryngology patient population. This is the first report of clinical outcomes of robot-assisted neck dissection by North American groups. This is a retrospective case-control study. Cases included three patients who underwent isolated, ipsilateral robot-assisted neck dissection. Operative time, estimated blood loss, lymph node retrieval, total drainage, hospital stay and complications from this group were compared against the outcomes of six consecutive patients who underwent conventional neck dissection. Operative times were longer in robot-assisted neck dissection (mean 234 min) compared with the conventional neck dissection (mean 110 min). There were no significant differences between the two groups in other outcomes. Robot-assisted selective neck dissection of levels II-IV is feasible through a modified facelift incision. Our initial data suggest that this procedure is surgically sound. It should be applied by experienced surgeons who wish to avoid a cervical incision.

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.