Minimally invasive neck surgery. Surgical feasibility and physiological effects of carbon dioxide insufflation in a unilateral subplatysmal approach

Neck dissection through a facelift incision

OBJECTIVES/HYPOTHESIS

To determine the feasibility and safety of neck dissection through a facelift incision.

STUDY DESIGN

Prospective case series.

METHODS

Cadavers and live subjects underwent neck dissection using a facelift incision with and without endoscopic assistance. In the live facelift neck dissection (FLND), the preoperative surgical indications, staging, adjuvant therapy, intraoperative technical procedure, pathology reports on lymph nodes, and short-term outcomes were reviewed.

RESULTS

FLND was successfully performed in four cadavers and four live subjects, including selective (less than five neck levels removed) and comprehensive (levels I-V removed) neck dissections. All levels were accessible through this approach, with additional retraction required for levels I and IV. Endoscopic assistance was required in one neck dissection for adequate visualization. Short-term complications and number of excised lymph nodes were comparable to those from traditional neck dissection approaches.

CONCLUSIONS

Open neck dissection through a facelift incision is feasible and offers an alternate approach to traditional incisions. This can be performed without requiring robotic assistance and with endoscopic assistance only in certain cases. Endoscopic assistance can offer enhanced visualization of the surgical field and complement open direct approaches in neck dissection. Although FLND offers improved cosmetic outcomes when compared to those of traditional neck incisions, further study is required to determine its efficacy and indications.

Use of minimally invasive parathyroidectomy techniques in sporadic primary hyperparathyroidism: systematic review

The past two decades have seen rapidly changing attitudes towards the surgical management of primary hyperparathyroidism. Advances in localisation techniques and confidence with endoscopy have led to the development of numerous minimally invasive parathyroidectomy approaches, including open minimal incision and endoscopic and video-assisted parathyroidectomy. This paper systematically reviews the evidence for these methods to determine: (1) whether these new, minimally invasive techniques are comparable to conventional bilateral neck exploration methods in terms of success and complication rate; and (2) if they are comparable, which technique is likely to be best for cosmesis, patient safety and patient satisfaction. A search of the Medline, Cochrane Reviews and Scopus databases was conducted, using a defined list of search parameters. Abstracts were compared against inclusion and exclusion criteria, before the full text was sought and analysed for data. The evidence from each study was then assessed, based on study quality, and a recommendation made based on the level of evidence available. There is level 1b evidence that minimally invasive surgery is comparable to bilateral neck exploration in terms of efficacy and complication rates. This paper recommends that the treatment of choice for solitary adenoma (in most healthcare centres) should be open minimal incision parathyroidectomy, due to advantages in operative duration, learning curve and cost-effectiveness.

The endoscopic approach to the neck: a review of the literature, and overview of the various techniques

BACKGROUND

The endoscopic surgical approach to the neck has reached the head and neck surgeons' view with a certain delay, compared to other fields of endoscopic procedures. This may be attributed to the tight work space and plenty of vital structures in the operating field. Since study groups described first attempts with endoscopic or video assisted removals of thyroid glands in the late nineties, selective neck dissections on animal models or cadaveric dissections were performed in 2003.

METHOD

The review consists of a Medline Search regarding the terms of endoscopic, video- assisted neck dissections, excision of neck lesions, thyroidectomy and submandibular resection and minimal access surgery. The three main procedures (selective neck dissection, submandibular resection and thyroidectomy) are described and reviewed in the following test.

RESULTS

Various techniques have been performed successfully and led to good clinical results. The studies described in literature other than for thyroidectomy often do not exceed the level of small series or case-reports.

CONCLUSION

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.