Robotic Neck Surgery Research Articles

Robot-assisted versus conventional neck dissection: a propensity score matched case-control study on perioperative and oncologic outcomes.

The widespread acceptance of robotic surgery is extending to oral procedures. The demand for minimally invasive techniques is driving research into the cosmetic and oncologic benefits of robotic neck surgery. This study used propensity score matching to analyze the clinical course and postoperative outcomes of robot-assisted neck dissections for oncologic efficacy and surgical safety. Between May 2020 and April 2024, 200 OSCC patients underwent surgery and 42 were excluded. The cohort included 158 patients, 128 of whom underwent unilateral neck dissection and 30 of whom underwent bilateral neck dissection. Robotic-assisted neck dissection (RAND) was performed in 36 patients while conventional transcervical neck dissection (CTND) was performed in 122 patients. Data analysis included several factors, including lymph node retrieval and perioperative outcomes, with 1:1 propensity score matching to ensure fairness. Each of the 39 neck specimens with 36 patients was selected. The CTND group was 8years older overall than the RAND group, but otherwise similar in terms of primary site and clinical stage. The RAND group had a 55-min longer operative time and 140cc more hemovac drainage than the CTND group, but the hospital stay and intensive care unit duration were the same, and the number of lymph nodes retrieved was the same. Survival rates also showed no difference across all stages. This shows that RAND is in no way inferior to CTND in terms of perioperative or oncologic outcomes, and demonstrates the safety of robot-assisted surgery, even in patients who require flaps or in patients with advanced stages.

Recent progress of robotic head and neck surgery using a flexible single port robotic system.

We performed robotic neck surgery through a transoral or retroauricular approach (RA) using the DaVinci SP and analyzed our experiences to evaluate the feasibility and safety of this system for performing RA neck surgeries. A total of 63 patients were enrolled in this study, consisting of 37 males and 26 females. All operations were successfully completed without significant complication in 63 patients with head and neck tumor. Using DaVinci SP, it is easy to insert three robotic arms into a long and narrow working space because all robotic arms and an endoscope are inserted through a single arm. Using the navigation function of the DaVinci SP, the endoscopic arm could be made into the shape of a "cobra" to secure proper visualization of the surgical site, which helps surgeons identify specific anatomic structures such as cranial nerve or vessels. We did not have any cases where robotic surgery was converted to open surgery due to severe bleeding or technical issues during surgery. The mean operative time was 207min and the average hospital stay was 6.9days. The time required for docking the surgical robot was within 10min on average for DaVinci SP, which was much simpler and faster than that of the previous Si/Xi system. Based on our early experiences performing robotic head and neck surgery using the DaVinci SP, we confirmed that the system provided advanced technical advantages over the previous Si/Xi system in performing robotic surgery.

Robotic Head and Neck Surgery: Beyond TORS.

To explore the advances in robotic head and neck surgery (HNS) beyond TORS. Although limited, the current literature corroborates the safety of robotic neck surgery, revealing similar surgical/oncologic outcomes, except longer operative time and superior cosmesis. In most of the remote thyroid approaches, use of robotic-assisted surgery is essential. However, for the recently popularized transoral approach, endoscopic technique has been preferred by most surgeons, due to longer operative time in robotic-assisted technique. On the other hand, retroauricular approach has been considered the standard for comprehensive/selective robotic neck dissections. Robotic technology has an increasing role in HNS. Robotic neck dissection has shown encouraging results, being routinely used in some centers around the globe. Robotic thyroid surgery, although safe when well applied, has lost ground to endoscopic transoral thyroidectomy. In the future, more evolved robotic systems could improve multiple areas of HNS.

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.

Minimally invasive retroauricular approaches to the neck: A paradigm shift

Introduction: The conventional approach for surgery of the thyroid and neck is performed through an open transcervical incision. Endoscopic and robotic neck surgery via retroauricular approach is a viable cosmetic alternative with improved functional outcomes. Materials and Methods: This is a retrospective analysis of patients who underwent endoscopic or robotic assisted neck surgeries from September 2016 to December 2019 at a tertiary cancer center in Eastern India. Results: A total of 54 patients were operated by the retroauricular approach. We encountered minimal complications and better cosmetic results compared to the standard open approach. A significant reduction in operative time over the course of the study was observed, signifying an easier learning curve. Conclusion: Retroauricular approach is a feasible cosmetic minimally invasive approach to neck surgeries with satisfactory functional outcomes, which may be implemented in developing country like ours where cosmesis is rapidly gaining popularity.

Robotic Neck Surgery in the Pediatric Population.

Introduction:Thyroid, parathyroid, and thymus surgeries are traditionally performed via a cervical approach. However, robot-assisted procedures can provide a safe alternative for neck surgeries. We report our experiences with robotic transaxillary and retroauricular approaches in pediatric patients.Case Presentation:We conducted a retrospective review of pediatric patients who underwent robot-assisted neck surgery by a single surgeon between April 2010 and May 2017. Patient demographics and surgical outcomes including operative time, incidence of complications, and length of hospital stay were evaluated.Management and Outcomes:Nine surgeries in 7 female patients were reviewed (mean age, 16.0 ± 1.58 years; mean body mass index, 22.5 ± 0.75). Two thyroid lobectomies, 2 complete thyroidectomies, 1 subtotal thyroidectomy, 1 thyroid lobectomy with thymectomy, 2 subtotal parathyroidectomies with thymectomy, and 1 dermoid cyst excision were performed. Two surgeries with the retroauricular approach had a mean surgical time of 142.0 ± 6.13 minutes. Seven surgeries with the transaxillary approach had a mean surgical time of 146.1 ± 21.01 minutes. There were no reported conversions, permanent vocal cord paralysis, permanent hypoparathyroidism, hematoma, or seroma. There was 1 case (11%) of temporary shoulder hypoesthesia and 2 cases of temporary vocal cord paresis (22%).Discussion:This series on robot-assisted neck surgeries in children describes procedures performed with robotic transaxillary and retroauricular approaches. In the hands of a high-volume surgeon the techniques are feasible and safe options for operations in the neck in a select group of pediatric patients.

Safe implementation of retroauricular robotic and endoscopic neck surgery in South America.

In the last three decades, otolaryngology and head and neck oncological surgery have shown remarkable progress with the development of several modalities of endoscopic-assisted minimally invasive surgeries. More recently, the Da Vinci robotic surgery system has promoted the development of several surgical approaches with less morbidity and better cosmetic results, including the transaxillary and retroauricular approaches for thyroid surgery and neck dissections. In South America, there are several shortcomings regarding financial resources as well as the lack of support for innovation leading to a significant delay in adoption of numerous technological advances in medical practice. Despite these obstacles, we obtained training in transoral robotic surgery and neck procedures, and then decided to implement neck endoscopic and robotic surgery at our institution. We developed a collaborative training program with Yonsei University that, together with several local measures, allowed for a safe implementation. From June 2014 to December 2016, we have performed a total of 121 retroauricular neck surgeries, of which 65 were robotic-assisted and 56 were endoscopic assisted procedures, with a complication rate that seems to be comparable to conventional procedures in our experience and a smooth learning curve. Safety compliance has been continuously assessed. Aiming to develop and disseminate these techniques, we have ongoing collaborative work with Yonsei University faculty, to continue increasing our clinical experience, and we are now preparing the group and infrastructure to establish a local training program for South American surgeons. We have been presenting our results at national and international medical meetings and started to publish the preliminary results in peer reviewed medical journals. The emphasis is that a retroauricular approach is a therapeutic option to be considered, especially for young patients. Media exposure has been avoided so far. As expected, resistance by our peers is still present and much more work is needed to overcome it, including the generation of data on the outcomes and a critical analysis of the advantages and disadvantages of endoscopic and robotic neck surgery.

The new era of robotic neck surgery: The universal application of the retroauricular approach.

Recent advances in technology has triggered the introduction of surgical robotics in the field of head and neck surgery and changed the landscape indefinitely. The advent of transoral robotic surgery and robotic thyroidectomy techniques has urged the extended applications of the robot to other neck surgeries including remote access surgeries. Based on earlier reports and our surgical experiences, this review will discuss in detail various robotic head and neck surgeries via retroauricular approach.

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.

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.

Robotic transaxillary total thyroidectomy through a single axillary incision

There is controversy in the literature about whether robotic total thyroidectomy should be performed through unilateral or bilateral axillary incisions. The aim of this study was to perform a detailed critical analysis of the single-incision technique with a focus on postoperative pain, morbidity, and oncologic outcomes. Between June 2009 and May 2012, 30 patients underwent robotic neck surgery through a single axillary incision. The perioperative outcomes of 16 patients who underwent robotic total thyroidectomy were compared with 30 consecutive patients undergoing conventional total thyroidectomy. Data were collected from a prospectively maintained, institutional review board-approved database. All data are presented as mean values ± standard error of the mean. Both groups were similar regarding age, gender, body mass index, tumor size, and tumor type. For all patients, skin-to-skin operative time (OT) was less in the conventional group (139 ± 8 vs 183 ± 11 minutes, respectively; P = .002). In the robotic group, a significant improvement of the OT occurred after the 6th case: 245 ± 12 minutes for the first 6 cases versus 153 ± 10 minutes for the last 10 cases (P < .001). Estimated blood loss was similar between groups. The median hospital stay was 1 day for both groups. The morbidity was 13% in the conventional and 19% in the robotic group (P = .631). Our results show that robotic total thyroidectomy through a single axillary incision is feasible, with similar short-term oncologic results. However, owing to the extent of dissection, the 2-week operative site discomfort is greater after robotic versus conventional total thyroidectomy.

Book Review: Atlas of Head and Neck Surgery: Endoscopic and Robotic Neck Surgery

Book Review: Atlas of Head and Neck Surgery: Endoscopic and Robotic Neck Surgery

Robotic endoscopic surgery in a porcine model of the infant neck.

Minimally invasive surgery is rapidly becoming the desired surgical standard, especially for pediatric patients. Infants and children are a particular technical challenge, however, because of the small size of target anatomical structures and the small surgical workspace. Computer-assisted robot-enhanced surgical telemanipulators may overcome these challenges by facilitating surgery in a small workspace. We studied the feasibility of performing robotic endoscopic neck surgery on a porcine model of the human infant neck. The study design was a prospective, feasibility pilot study of a small cohort for proof of concept and for a survival model. Sixteen non-survival piglets weighing 4.5–10 kg were used to develop the surgical approach and operative technique. Eight piglets aged 3–6 weeks old and weighing 4.0–9.1 kg underwent survival thyroidectomy by a cervical endoscopic approach using the Zeus surgical robot, which includes the Aesop endoscope holder and “Microwrist” microdissecting instruments. We succeeded in performing endoscopic robotic neck surgery on a piglet as small as 4 kg, in an operative pocket as small as 2 cm3. Total incision length for all three ports was ≤23 mm. There were no major complications, no major robotic instrument malfunctions or breakages, and no procedures required conversion to open surgery. These results support the feasibility of robotic endoscopic neck surgery on a neck the size of a human infant’s.Electronic supplementary materialThe online version of this article (doi: 10.1007/s11701-006-0007-5) contains supplementary material, which is available to authorized users.