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Sayan A, Ganesarajah T, Baheerathan N, Ilankovan V. Do we still need Crile or Hayes Martin approach for cervical lymphadenectomy? A retrospective study of 56 patients with minimal access neck dissection. Br J Oral Maxillofac Surg 2024; 62:471-476. [PMID: 38685146 DOI: 10.1016/j.bjoms.2024.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/22/2024] [Accepted: 01/30/2024] [Indexed: 05/02/2024]
Abstract
The concept of neck dissection was introduced by Crile more than a century ago. Since then, multiple modifications have been adopted to ensure the preservation of vital structures. With the new era of minimal access surgery, the incorporation of laparoscopic, endoscopic, and robotic surgery is becoming the new normal. Over the years we have carried out neck dissections using minimal access incisions. Although there is no definitive answer about the average nodal yield required in selective or modified neck dissections, it has been reported that the average nodal yield of more than 18 is associated with better survival rate. In this publication we share the results of our three-year retrospective study of 56 patients who underwent minimal access neck dissection. We look at the nodal yield, assess operating duration, complications, outcome with a three-year follow up from a single unit. Our results demonstrate that minimal access neck dissection should be considered in head and neck lymphadenectomies.
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Affiliation(s)
- Anna Sayan
- Poole Hospital, University Hospital Dorset NHS Foundation Trust, United Kingdom.
| | | | - Nall Baheerathan
- Poole Hospital, University Hospital Dorset NHS Foundation Trust, United Kingdom
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Snyder V, Smith B, Kim S, Spector ME, Duvvuri U. Evaluation of the safety and effectiveness of robot-assisted neck dissections. Head Neck 2024; 46:1331-1339. [PMID: 38488336 DOI: 10.1002/hed.27731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/27/2024] [Accepted: 03/03/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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). CONCLUSION 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.
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Affiliation(s)
- Vusala Snyder
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Brandon Smith
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Seungwon Kim
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Matthew E Spector
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Umamaheswar Duvvuri
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Krishnan G, Cousins A, Pham N, Milanova V, Nelson M, Krishnan S, van den Berg NS, Shetty A, Rosenthal EL, Wormald P, Thierry B, Foreman A, Krishnan S. Preclinical feasibility of robot-assisted sentinel lymph node biopsy using multi-modality magnetic and fluorescence guidance in the head and neck. Head Neck 2022; 44:2696-2707. [PMID: 36082404 PMCID: PMC9825899 DOI: 10.1002/hed.27177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/08/2022] [Accepted: 08/16/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Sentinel lymph node biopsy (SLNB) is a staging procedure dependent on accurate mapping of draining lymphatics via tracers. Robot-assisted SLNB enables access to multiple neck levels with a single incision and intraoperative fluorescence guidance to the SLN. METHODS Lymphatic mapping in swine was done using a magnetic tracer and fluorescent dye, injected into the tongue. MRI preoperatively mapped lymphatic spread of the magnetic tracer. Dissection was performed using a da Vinci Xi robot guided by fluorescence-imaging of the dye. RESULTS Robot-assisted SLNB was successfully performed in all animals (n = 5). A novel MRI protocol differentiated SLNs (n = 6) from lower echelon nodes (n = 11) based on flow progression. Fluorescence imaging provided valuable intraoperative guidance and correlated with magnetic-positive nodes. CONCLUSIONS This study demonstrates preclinical feasibility of a robot-assisted approach to SLNB using magnetic and fluorescent tracers in the head and neck, enabling both preoperative mapping and intraoperative guidance.
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Affiliation(s)
- Giri Krishnan
- Department of Otolaryngology, Head and Neck SurgeryThe University of AdelaideAdelaideSouth AustraliaAustralia
| | - Aidan Cousins
- Future Industries InstituteUniversity of South Australia, Mawson Lakes CampusAdelaideSouth AustraliaAustralia
| | - Nguyen Pham
- Key Centre for Polymers and Colloids, School of Chemistry and University of Sydney Nano InstituteThe University of SydneySydneyNew South WalesAustralia
| | - Valentina Milanova
- Future Industries InstituteUniversity of South Australia, Mawson Lakes CampusAdelaideSouth AustraliaAustralia
| | | | - Shridhar Krishnan
- Department of Oral and Maxillofacial SurgeryThe University of AdelaideAdelaideSouth AustraliaAustralia
| | - Nynke S. van den Berg
- Department of Otolaryngology—Division of Head and Neck SurgeryStanford University School of MedicineStanfordCaliforniaUSA
| | - Anil Shetty
- Ferronova Pty LtdAdelaideSouth AustraliaAustralia
| | - Eben L. Rosenthal
- Department of Otolaryngology—Division of Head and Neck SurgeryStanford University School of MedicineStanfordCaliforniaUSA
| | - Peter‐John Wormald
- Department of Otolaryngology, Head and Neck SurgeryThe University of AdelaideAdelaideSouth AustraliaAustralia
| | - Benjamin Thierry
- Future Industries InstituteUniversity of South Australia, Mawson Lakes CampusAdelaideSouth AustraliaAustralia
| | - Andrew Foreman
- Department of Otolaryngology, Head and Neck SurgeryThe University of AdelaideAdelaideSouth AustraliaAustralia
| | - Suren Krishnan
- Department of Otolaryngology, Head and Neck SurgeryThe University of AdelaideAdelaideSouth AustraliaAustralia
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Lee YC, Hsin LJ, Yang SW, Tsai MS, Tsai YT, Ho CF. Endoscope-assisted versus conventional neck dissection in patients with oral cancer: a systematic review and meta-analysis. J Otolaryngol Head Neck Surg 2022; 51:20. [PMID: 35546415 PMCID: PMC9097363 DOI: 10.1186/s40463-022-00567-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 02/26/2022] [Indexed: 11/17/2022] Open
Abstract
Background Neck dissection is an integral component of the treatment of head and neck cancers. The present meta-analysis aimed to compare the use of endoscope-assisted neck dissection (END) with conventional neck dissection (CND) in the existing English literature. Methods A search of PubMed (MEDLINE), Embase, and the Cochrane Library for articles reporting the results of the two techniques of neck dissection was completed independently by two individuals. The authors analyzed the data from each study using a random-effects model. Results The pooled analysis demonstrated comparable lymph node yield, intraoperative blood loss, incidence of locoregional recurrence, and incidence of complications between the two groups. A significantly longer operative time but a shorter length of hospital stay was observed in the END group compared with the other group. Conclusions Compared with conventional techniques, END offers similar oncologic outcomes and complication rates; however, it requires a longer operative time. Future studies with long-term follow-up and assessment of patient satisfaction are needed to confirm the clinical use of END. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s40463-022-00567-9.
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Affiliation(s)
- Yi-Chan Lee
- Department of Otolaryngology - Head and Neck Surgery, Chang Gung Memorial Hospital, No. 222, Maijin Rd., Anle Dist., Keelung City, 204, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Li-Jen Hsin
- Department of Otolaryngology - Head and Neck Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Wei Yang
- Department of Otolaryngology - Head and Neck Surgery, Chang Gung Memorial Hospital, No. 222, Maijin Rd., Anle Dist., Keelung City, 204, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Shao Tsai
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yao-Te Tsai
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Che-Fang Ho
- Department of Otolaryngology - Head and Neck Surgery, Chang Gung Memorial Hospital, No. 222, Maijin Rd., Anle Dist., Keelung City, 204, Taiwan. .,College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Chen S, Zhao M, Wang D, Zhao Y, Qiu J, Liu Y. Endoscopic and Robotic Parotidectomy for the Treatment of Parotid Tumors: A Systematic Review and Meta-Analysis. Front Oncol 2021; 11:748885. [PMID: 34900694 PMCID: PMC8660082 DOI: 10.3389/fonc.2021.748885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/18/2021] [Indexed: 11/13/2022] Open
Abstract
Background The goal of this review was to introduce endoscopic/robotic parotidectomy (EP/RP) and compare EP/RP against conventional parotidectomy (CP) regarding the intraoperative and postoperative parameters in the treatment of parotid tumors. Methods A systematic literature search of medical databases (PubMed, Embase, and Cochrane Central Register of Controlled Trials) was performed from inception to November 2020 to generate relevant studies. Results A total of 13 eligible studies (572 patients) were included for systematic review, and 7 out of 13 comparable studies for the quantitative synthesis of outcomes. Patients who underwent EP were characterized by less intraoperative bleeding volume, shorter incision length, and higher satisfaction postoperatively (WMD, 95% CI, -42.80; - 58.23 to -27.37; p < 0.01; WMD, 95% CI, -5.64; -7.88 to -3.39; p < 0.01; SMD, 95% CI, 1.88; 1.46 to 2.31; p < 0.01, respectively). However, operative time and risk of facial palsy exhibited no significant differences (WMD, 95% CI, -11.17; -26.71 to 4.34; p = 0.16; OR, 95% CI,0.71; 0.39 to 1.32; p = 0.28, respectively). Conclusions Our findings suggest that the current evidence does not adequately support EP is equally safe and effective as CP. In certain selected cases, endoscopic technology has its unique advantages. For patients with strong cosmetic needs, endoscopic or robotic techniques may be an alternative through adequate preoperative evaluations. Systematic Review Registration International Prospective Register of Systematic Reviews, identifier CRD42020210299.
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Affiliation(s)
- Shanwen Chen
- Department of Otorhinolaryngology - Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Mei Zhao
- Oncology Department of Integrated Traditional Chinese and Western Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Dong Wang
- Department of Otorhinolaryngology - Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yi Zhao
- Department of Otorhinolaryngology - Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jianxin Qiu
- Department of Otorhinolaryngology - Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yehai Liu
- Department of Otorhinolaryngology - Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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Jat B, Majumdar KS, Thaduri A, Usmani SA, Dave J, Kumar A, Tyagi AK. Robot assisted modified retro-auricular approach for posterior triangle of neck: The path differently taken. Oral Oncol 2021; 124:105633. [PMID: 34856510 DOI: 10.1016/j.oraloncology.2021.105633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 11/10/2021] [Accepted: 11/14/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Bhinyaram Jat
- Department of Otorhinolaryngology and Head & Neck Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
| | - Kinjal Shankar Majumdar
- Department of Otorhinolaryngology and Head & Neck Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Abhinav Thaduri
- Department of Otorhinolaryngology and Head & Neck Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Shahab Ali Usmani
- Department of Otorhinolaryngology and Head & Neck Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Jay Dave
- Department of Otorhinolaryngology and Head & Neck Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Amit Kumar
- Department of Otorhinolaryngology and Head & Neck Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Amit Kumar Tyagi
- Department of Otorhinolaryngology and Head & Neck Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Elzahaby IA, Shetiwy M, Hossam A, Elafy A. Endoscopic Cervical Lymph Node Dissection Using the Extra-cervical Anterior Chest Wall Approach: A New Technique. Surg Innov 2021; 29:723-729. [PMID: 34823394 DOI: 10.1177/15533506211057633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION This study aims to demonstrate the safety, surgical feasibility, and esthetic features of total endoscopic neck dissection (END) through anterior chest wall approach (ACWA) without creation of any neck incisions. Resection of their primary tumors followed by selective total END through ACWA using 3 ports (one 10-mm port for the camera and two 5-mm ports for the working instruments). METHODS From January 2020 to August 2020, 6 patients with a biopsy proven head and neck carcinoma underwent resection of their primary tumors followed by selective total END through ACWA using 3 ports (one 10-mm port for the camera and two 5-mm ports for the working instruments). RESULTS The selective neck dissection was successfully performed endoscopically in all cases with no conversion to open approach and with good visualization of the major neurovascular structures. The operative time for the END ranged from 120 to 170 minutes, with 10-50 mL estimated blood loss. No significant perioperative complications were encountered. The mean total number of cervical LN retrieved was 13.67 + 2.42, and the mean LNR was .01 + .13. All patients were discharged in the third postoperative day, and they were satisfied with the cosmetic outcome. CONCLUSION Selective total END through ACWA is technically feasible and safe with satisfactory cosmetic results. The absence of neck scars and magnification of the important neurovascular structures are the most obvious advantages of this innovative technique. It may be a valid alternative to conventional surgery when performed in selected patients. However, further research with longer follow up is needed to clarify the oncological safety and the real benefits of END in head and neck cancer patients.
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Affiliation(s)
- Islam A Elzahaby
- Lecturer of Surgical Oncology, RinggoldID:243489Mansoura University, Mansoura, Daqahlia, Egypt
| | - Mosab Shetiwy
- Lecturer of Surgical Oncology, RinggoldID:243489Mansoura University, Mansoura, Daqahlia, Egypt
| | - Amr Hossam
- Lecturer of Surgical Oncology, RinggoldID:243489Mansoura University, Mansoura, Daqahlia, Egypt
| | - Amr Elafy
- Lecturer of Surgical Oncology, RinggoldID:243489Mansoura University, Mansoura, Daqahlia, Egypt
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Kowalski LP, Lira RB. Anatomy, technique, and results of robotic retroauricular approach to neck dissection. Anat Rec (Hoboken) 2021; 304:1235-1241. [DOI: 10.1002/ar.24621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/15/2021] [Accepted: 02/16/2021] [Indexed: 11/08/2022]
Affiliation(s)
- Luiz P. Kowalski
- Head and Neck Surgery Department University of Sao Paulo Medical School Sao Paulo Brazil
- Head and Neck Surgery and Otorhinolaryngology Department A. C. Camargo Cancer Center Sao Paulo Brazil
| | - Renan B. Lira
- Head and Neck Surgery and Otorhinolaryngology Department A. C. Camargo Cancer Center Sao Paulo Brazil
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Abstract
PURPOSE OF REVIEW The progressive growth of endoscopic and robotic-assisted procedures provided the tools for development of remote approaches to the neck, which could avoid a visible large neck scar usually necessary for neck dissections. This review explores the current experience with robotic neck dissection, looking for pros and cons in surgical, oncologic and aesthetic outcomes. RECENT FINDINGS Robotic neck dissection was shown to be feasible and well tolerated, with adequate oncological outcomes in different tumours. Although difficult to objectively analyse, cosmetic satisfaction seems to be significatively higher in patients submitted to this procedure when compared with those submitted to conventional neck dissection. The only consistently reported disadvantage was longer operative time. Other potential advantages beyond cosmesis such as improvements on oedema, fibrosis, neck movement, sensory loss and social interactions were not well explored so far. SUMMARY Surgical treatment of neck metastasis had several evolutions in the last decades. Robotic neck dissection emerged as an option to avoid extensive visible neck scars, improving cosmesis and probably other functional outcomes, although securing oncologic effectiveness. Technological innovation is increasingly dynamic, promising progressive evolution in robotic surgery. Together, the lack of objective data on functional outcomes warrants the need for further investigation on robotic neck dissection.
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Comparing Technical Feasibility of Non-robotic Retroauricular Versus Transcervical Approach Neck Dissection in Oral Cancers-a Preliminary Single Institute Experience. Indian J Surg Oncol 2020; 11:589-596. [PMID: 33299277 DOI: 10.1007/s13193-020-01252-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 10/15/2020] [Indexed: 01/29/2023] Open
Abstract
Recent advances in minimal access/invasive surgeries in head and neck (robotic/endoscopic assisted) allow neck dissection without a visible scar through a retroauricular approach unlike conventional approach giving visible scar and its sequelae. We retrospectively reviewed prospectively collected data of 80 neck dissections in 72 patients from April 2017 to June 2018 for all newly diagnosed squamous cell carcinoma of oral cavity. We compared between the operative and postoperative outcomes in open- and endoscopic-assisted retroauricular approach (RA) in these patients undergoing neck dissections. Thirty-two out of seventy-two patients underwent retroauricular (RA) approach neck dissection while 40/72 patients underwent conventional open approach neck dissection. RA group had more early staged oral cancers 20/32 (62.5%) as compared to 9/40 (22.5%) in the open approach (p = 0.025). Average nodal yield and nodal yield according to levels were not statistically different in both groups. Nodal failure in both groups was also not statistically significant (p = 0.82). Postoperative complications like marginal weakness, hematoma, microvascular-related problems, and wound problems were not significantly related to the type of approach. We recommend in select group of early oral cancers the retroauricular-assisted neck dissection as minimally invasive, cost-effective, and oncologically safe approach for a scar-free neck surgery.
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Pawar P, Vaishampayan S, Shah DH, Pai A. Retro-auricular endo assisted selective neck dissection (how I do it). Oral Oncol 2020; 110:104942. [PMID: 32827834 DOI: 10.1016/j.oraloncology.2020.104942] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 07/04/2020] [Accepted: 07/28/2020] [Indexed: 10/23/2022]
Abstract
Elective neck dissection (END) is preferred in all treatment naïve patients with invasive oral squamous cell carcinoma (OSCC), including the early stage, node negative cases (T1/T2 N0). Usually the conventional horizontal neck crease incision leads to a faintly visible scar in the neck. However sometimes, the neck scar is hypertrophic and is highly unaesthetic and psychologically distressing to the patient. Retro-auricular hairline approach has been popularized in the Robot assisted neck dissections (RoAND), to avoid easily visible scar in neck crease. We have been using the retro-auricular incision for selective neck dissection in early invasive OSCCs using an assembly of customized retractors as an open approach with only occasional use of endoscopes. This approach to the neck surgery is oncologically safe, reproducible and economical. It is cosmetically superior as the scar of neck dissection is in a less conspicuous area of the face, hidden behind the ear and in the hairline.
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Affiliation(s)
- Prashant Pawar
- Head and Neck and Skull Base Surgery, Apollo Hospital, Navi Mumbai, Maharashtra, India
| | - Sagar Vaishampayan
- Department of Oral and Maxillofacial Surgery, MGM's Dental College and Hospital, Navi Mumbai, Maharashtra, India
| | - Dinesh H Shah
- Head and Neck Services, Tata Memorial Hospital, Dr E Borges Road, Parel, Mumbai, Maharashtra, India.
| | - Ameya Pai
- Observer Head and Neck Services, Tata Memorial Hospital, Dr E Borges Road, Parel, Mumbai, Maharashtra, India
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Sharan R, Chakraborty P, Arun P, Manikantan K, Vijay J. Minimally invasive retroauricular approaches to the neck: A paradigm shift. JOURNAL OF HEAD & NECK PHYSICIANS AND SURGEONS 2020. [DOI: 10.4103/jhnps.jhnps_7_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Nayak SP, Devaprasad M, Khan A. Minimally invasive neck dissection: A 3-year retrospective experience of 45 cases. J Minim Access Surg 2019; 15:293-298. [PMID: 29974878 PMCID: PMC6839352 DOI: 10.4103/jmas.jmas_40_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 05/15/2018] [Indexed: 11/19/2022] Open
Abstract
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.
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Affiliation(s)
- Sandeep P. Nayak
- Department of Surgical Oncology, Fortis Hospital, Karnataka, India
- MACS Clinic, Bengaluru, Karnataka, India
| | - M. Devaprasad
- Department of Surgical Oncology, Fortis Hospital, Karnataka, India
- MACS Clinic, Bengaluru, Karnataka, India
| | - Ameenudhin Khan
- Department of Surgical Oncology, Fortis Hospital, Karnataka, India
- MACS Clinic, Bengaluru, Karnataka, India
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Robotic-Assisted Modified Radical Neck Dissection: Transaxillary, Bilateral Axill-Breast Approach (BABA), Facelift. CURRENT SURGERY REPORTS 2019. [DOI: 10.1007/s40137-019-0241-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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16
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Arora R, Verma VK, Mishra KS, Bhoye H, Kapoor R. Reconstruction with free flaps in robotic head-and-neck onco-surgeries. Indian J Plast Surg 2019; 51:283-289. [PMID: 30983727 PMCID: PMC6440359 DOI: 10.4103/ijps.ijps_35_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Aims and Objective: The aim of the present article is to highlight how reconstruction with free flaps is different and difficult in cases with robotic head-and-neck cancer surgery. It also highlights the technical guidelines on how to manage the difficulties. Materials and Methods: Eleven patients with oropharyngeal cancer having undergone tumour excision followed by free-flap reconstruction been reviewed here. Nine patients had tumour excision done robotically through intraoral route while neck dissection done with transverse neck crease incision. There is a problem of difficult flap inset in this group of patient. Two patients had intraoral excision of tumour followed by robotic neck dissection via retroauricular incision. With no incision directly on the neck, microvascular anastomosis is challenging in this set of patients. Free flap was used in all the cases to reconstruct the defect. Results: Successful reconstruction with free flap was done in all the cases with good outcome both functionally and aesthetically. Conclusion: Free-flap reconstruction is possible in robotic head-and-neck cancer surgery despite small and difficult access, but it does need practice and some technical modifications for good outcome.
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Affiliation(s)
- Rajan Arora
- Department of Surgical Oncology, Division of Plastic and Reconstructive Surgery, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Vinay Kumar Verma
- Department of Surgical Oncology, Division of Plastic and Reconstructive Surgery, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Kripa Shanker Mishra
- Department of Surgical Oncology, Division of Plastic and Reconstructive Surgery, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Hemant Bhoye
- Department of Surgical Oncology, Division of Plastic and Reconstructive Surgery, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Rahul Kapoor
- Department of Surgical Oncology, Division of Plastic and Reconstructive Surgery, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
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Sukato DC, Ballard DP, Abramowitz JM, Rosenfeld RM, Mlot S. Robotic versus conventional neck dissection: A systematic review and meta-analysis. Laryngoscope 2018; 129:1587-1596. [DOI: 10.1002/lary.27533] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Indexed: 12/21/2022]
Affiliation(s)
- Daniel C. Sukato
- Department of Otolaryngology; SUNY Downstate Medical Center; Brooklyn New York U.S.A
| | - Daniel P. Ballard
- Department of Otolaryngology; SUNY Downstate Medical Center; Brooklyn New York U.S.A
| | - Jason M. Abramowitz
- Department of Otolaryngology; SUNY Downstate Medical Center; Brooklyn New York U.S.A
| | - Richard M. Rosenfeld
- Department of Otolaryngology; SUNY Downstate Medical Center; Brooklyn New York U.S.A
| | - Stefan Mlot
- Department of Otolaryngology; SUNY Downstate Medical Center; Brooklyn New York U.S.A
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Lira RB, Chulam TC, Kowalski LP. Variations and results of retroauricular robotic thyroid surgery associated or not with neck dissection. Gland Surg 2018; 7:S42-S52. [PMID: 30175063 DOI: 10.21037/gs.2018.03.04] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background Technological advances in the last decades allowed significant evolution in head and neck surgery toward less invasive procedures, with better esthetic and functional outcomes, without compromising oncologic soundness. Although robotic thyroid surgery has been performed for some years now and several published series reported its safety and feasibility, it remains the center of significant controversy. This study shows the results of a case series of robotic thyroid surgery, combined or not with robotic neck dissection. Methods A retrospective cohort including 48 cases of robotic thyroid surgery with or without neck dissection, using retroauricular or combined approaches, performed in a tertiary cancer center, comprised the study. Results Between 2015 and 2017, we performed 2,769 thyroid surgical procedures, of which 48 (1.7%) were robot-assisted, in 46 patients [26 hemithyroidectomies, 7 total thyroidectomies, and 12 total thyroidectomies (or totalization) with selective neck dissection (SND) II-VI; and 3 neck dissections for thyroid carcinoma]. There were 43 (89.6%) women, and the median age was 35 years. The mean hospital stay was 1.9 days. In 3 (6.2%) cases, drains were not placed (hemithyroidectomies), whereas the other 45 (93.8%) cases had a mean drain stay of 4.4 days (range, 1-9 days). The console time (robotic thyroid resection and neck dissection) ranged from 11 to 200 min (mean 66.1 min; median 40 min), and the total operating room time ranged from 80 to 440 min (mean 227.9 min; median 170 min). Three (6.2%) patients had transient vocal cord paresis. Transient hypocalcemia was reported in three cases (6.2%). There were 30 carcinomas (62.5%), and the mean number of retrieved lymph nodes (LNs) (considering only cases that included robotic neck dissection) was 27.2 (range, 17-40). The mean follow-up time was 17.4 months (range, 1.4-31.9 months), and no recurrence was diagnosed. Conclusions The quality outcomes and complication rates are comparable to the conventional approaches. Therefore, robotic thyroidectomy can be an option for selected patients that are motivated to avoid a visible neck scar, treated in high-volume centers. For the patients who require lateral neck dissection, the retroauricular robotic approach could be even more attractive, especially for young patients.
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Affiliation(s)
- Renan Bezerra Lira
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, Sao Paulo, Brazil
| | - Thiago Celestino Chulam
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, Sao Paulo, Brazil
| | - Luiz Paulo Kowalski
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, Sao Paulo, Brazil
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Morisod B, Guinchard AC, Gorphe P, Schweizer V, Sandu K, Simon C. Transoral robotic-assisted supracricoid partial laryngectomy with cricohyoidoepiglottopexy: Procedure development and outcomes of initial cases. Head Neck 2018; 40:2254-2262. [DOI: 10.1002/hed.25332] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 01/14/2018] [Accepted: 04/19/2018] [Indexed: 11/06/2022] Open
Affiliation(s)
- Benoît Morisod
- Department of Otolaryngology - Head and Neck Surgery, Centre Hospitalier Universitaire Vaudois (CHUV); University of Lausanne; Lausanne Suisse
| | - Anne-Claude Guinchard
- Department of Otolaryngology - Head and Neck Surgery, Centre Hospitalier Universitaire Vaudois (CHUV); University of Lausanne; Lausanne Suisse
| | - Philippe Gorphe
- Department of Head and Neck Oncology; Institute Gustave Roussy; Villejuif France
| | - Valerie Schweizer
- Department of Otolaryngology - Head and Neck Surgery, Centre Hospitalier Universitaire Vaudois (CHUV); University of Lausanne; Lausanne Suisse
| | - Kishore Sandu
- Department of Otolaryngology - Head and Neck Surgery, Centre Hospitalier Universitaire Vaudois (CHUV); University of Lausanne; Lausanne Suisse
| | - Christian Simon
- Department of Otolaryngology - Head and Neck Surgery, Centre Hospitalier Universitaire Vaudois (CHUV); University of Lausanne; Lausanne Suisse
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20
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Park YM, Quan YH, Kwon KH, Cho JG, Woo JS, Kim BM, Lee YS, Jeong JM, Kim HK, Song JJ. Endoscopic sentinel lymph node biopsy using indocyanine green-neomannosyl human serum albumin. Laryngoscope 2017; 128:E135-E140. [DOI: 10.1002/lary.27036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 10/13/2017] [Accepted: 11/08/2017] [Indexed: 01/30/2023]
Affiliation(s)
- Young Min Park
- Department of Otorhinolaryngology-Head and Neck Surgery; Seoul Republic of Korea
| | - Yu Hua Quan
- Department of Thoracic and Cardiovascular Surgery; Korea University College of Medicine; Seoul Republic of Korea
- Department of Biomedical Sciences, College of Medicine; Korea University; Seoul Republic of Korea
| | - Ki Hyeok Kwon
- Department of Interdisciplinary Bio/Micro System Technology; Korea University College of Engineering; Seoul Republic of Korea
| | - Jae-Gu Cho
- Department of Otorhinolaryngology-Head and Neck Surgery; Seoul Republic of Korea
| | - Jeong-Soo Woo
- Department of Otorhinolaryngology-Head and Neck Surgery; Seoul Republic of Korea
| | - Beop-Min Kim
- Department of Interdisciplinary Bio/Micro System Technology; Korea University College of Engineering; Seoul Republic of Korea
- Department of Bio-convergence Engineering, School of Biomedical Engineering; Korea University College of Health Science; Seoul Republic of Korea
| | - Yun-Sang Lee
- Department of Nuclear Medicine, College of Medicine; Seoul National University; Seoul Republic of Korea
| | - Jae Min Jeong
- Department of Nuclear Medicine, College of Medicine; Seoul National University; Seoul Republic of Korea
| | - Hyun Koo Kim
- Department of Thoracic and Cardiovascular Surgery; Korea University College of Medicine; Seoul Republic of Korea
- Department of Biomedical Sciences, College of Medicine; Korea University; Seoul Republic of Korea
| | - Jae-Jun Song
- Department of Otorhinolaryngology-Head and Neck Surgery; Seoul Republic of Korea
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21
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Ji YB, Song CM, Bang HS, Park HJ, Lee JY, Tae K. Functional and cosmetic outcomes of robot-assisted neck dissection by a postauricular facelift approach for head and neck cancer. Oral Oncol 2017. [DOI: 10.1016/j.oraloncology.2017.05.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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22
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Lira RB, Chulam TC, Kowalski LP. Safe implementation of retroauricular robotic and endoscopic neck surgery in South America. Gland Surg 2017; 6:258-266. [PMID: 28713697 DOI: 10.21037/gs.2017.03.17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
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.
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Affiliation(s)
- Renan Bezerra Lira
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, Sao Paulo, Brazil
| | - Thiago Celestino Chulam
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, Sao Paulo, Brazil
| | - Luiz Paulo Kowalski
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, Sao Paulo, Brazil
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Lira RB, Chulam TC, de Carvalho GB, Schreuder WH, Koh YW, Choi EC, Kowalski LP. Retroauricular endoscopic and robotic versus conventional neck dissection for oral cancer. J Robot Surg 2017; 12:117-129. [DOI: 10.1007/s11701-017-0706-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 04/24/2017] [Indexed: 10/19/2022]
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Ahn D, Sohn JH, Lee GJ, Hwang KH. Feasibility of using the retroauricular approach without endoscopic or robotic assistance for excision of benign neck masses. Head Neck 2017; 39:748-753. [PMID: 28067967 DOI: 10.1002/hed.24678] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2016] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The purpose of this study was to present our evaluation of the feasibility of using a retroauricular approach for excision of benign upper neck mass lesions without assistance of an endoscopic or robotic system. METHODS We enrolled 23 patients with benign neck mass lesions of the parotid gland, submandibular gland, and the level II/III region who underwent surgery via a retroauricular approach. RESULTS In 22 of 23 patients (95.7%), parotidectomies, submandibular gland resections, and mass excisions were successfully completed under direct vision, without endoscopic or robotic assistance. Mean operation time, drainage amount, and drainage duration were 99.1 minutes, 44.3 mL, and 2.9 days, respectively. For a total of 23 patients, the mean visual analog scale score for subjective satisfaction with the incision scar was 8.9. No serious or permanent complications occurred. CONCLUSION Excision using a retroauricular approach under direct vision is technically feasible for many benign mass lesions of the parotid gland, submandibular gland, and levels II/III of the neck region. © 2017 Wiley Periodicals, Inc. Head Neck 39: 748-753, 2017.
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Affiliation(s)
- Dongbin Ahn
- Department of Otolaryngology - Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jin Ho Sohn
- Department of Otolaryngology - Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Gil Joon Lee
- Department of Otolaryngology - Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Ki Ha Hwang
- Department of Otolaryngology - Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
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Feasibility of robot-assisted modified radical neck dissection by post-auricular facelift approach. Int J Oral Maxillofac Surg 2016; 45:1351-1357. [DOI: 10.1016/j.ijom.2016.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 03/15/2016] [Accepted: 05/11/2016] [Indexed: 01/30/2023]
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26
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Liang F, Fan S, Han P, Cai Q, Lin P, Chen R, Yu S, Huang X. Endoscopic-assisted selective neck dissection via small lateral neck incision for early-stage (T1-2N0M0) head and neck squamous cell carcinoma: 3-year follow-up results. Surg Endosc 2016; 31:894-900. [DOI: 10.1007/s00464-016-5051-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 06/13/2016] [Indexed: 10/21/2022]
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Sung ES, Ji YB, Song CM, Yun BR, Chung WS, Tae K. Robotic Thyroidectomy. Otolaryngol Head Neck Surg 2016; 154:997-1004. [DOI: 10.1177/0194599816636366] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 02/09/2016] [Indexed: 11/16/2022]
Abstract
Objectives Robotic thyroidectomy using remote access approaches has gained popularity with patients seeking to avoid neck scarring and enhanced cosmetic satisfaction. The aim of this study was to compare the efficacy and advantages of a postauricular facelift approach vs a gasless unilateral axillary (GUA) approach in robotic thyroidectomy. Study Design Case series with chart review. Setting University tertiary care hospital. Subjects and Methods We retrospectively analyzed the data of 65 patients who underwent robotic thyroidectomy with or without central neck dissection using a GUA approach (45 patients) or a postauricular facelift approach (20 patients) between September 2013 and December 2014. We excluded patients who underwent simultaneous lateral neck dissection or completion thyroidectomy. Results Robotic procedures were completed without being converted to an open procedure in all patients. There were no significant differences in terms of patient and tumor characteristics, extent of thyroidectomy and central neck dissection, operative time, complications, and postoperative pain between the 2 approaches, except the higher female ratio in the GUA approach group (female ratio, 95.6% vs 75%, P = .042). Cosmetic satisfaction evaluated by a questionnaire was not significantly different between the 2 groups, and most patients of both groups (85.7%) were satisfied with postoperative cosmesis. Conclusion Both GUA and postauricular facelift approaches are feasible, with no significant adverse events in patients, and result in excellent cosmesis. However, a GUA approach seems to be superior when performing total thyroidectomy using a unilateral incision based on the preliminary result.
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Affiliation(s)
- Eui Suk Sung
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, South Korea
| | - Yong Bae Ji
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, South Korea
| | - Chang Myeon Song
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, South Korea
| | - Bo Ram Yun
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, South Korea
| | - Won Sang Chung
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, Hanyang University, Seoul, South Korea
| | - Kyung Tae
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, South Korea
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Lira RB, Chulam TC, Koh YWW, Choi ECC, Kowalski LP. Retroauricular Endoscope-Assisted Approach to the Neck: Early Experience in Latin America. Int Arch Otorhinolaryngol 2016; 20:138-44. [PMID: 27096018 PMCID: PMC4835336 DOI: 10.1055/s-0036-1578807] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 12/06/2015] [Indexed: 11/08/2022] Open
Abstract
Introduction There has been a significant increase in concern towards improving aesthetic and functional outcomes without compromising the oncologic effectiveness in head and neck surgery. In this subset, endoscope-assisted and robotic procedures allowed the development of new approaches to the neck, including the retroauricular access, which is now routinely used, especially in Korea. Objectives This study aims to provide a descriptive analysis of our initial experience with retroauricular endoscope-assisted approach assessing feasibility, safety, and aesthetic results. Methods Prospective analysis of the first 11 eligible patients submitted to retroauricular endoscope-assisted approach for neck procedures in the Head and Neck Surgery Department at AC Camargo Cancer Center. Results A total of 18 patients were included in this study, comprising 7 supraomohyoid neck dissections, 8 submandibular gland excisions, 3 thyroid lobectomies, and one paraganglioma excision. There was no significant local complications, surgical accident, or need for conversion into conventional open procedure in this series. Conclusion Our initial experience has shown us that this approach is feasible, safe, oncologically efficient, and applicable to selected cases, with a clear cosmetic benefit.
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Affiliation(s)
- Renan Bezerra Lira
- Department of Head and Neck Surgery and Otorhinolaryngology, AC Camargo Cancer Center, São Paulo, SP, Brazil
| | - Thiago Celestino Chulam
- Department of Head and Neck Surgery and Otorhinolaryngology, AC Camargo Cancer Center, São Paulo, SP, Brazil
| | - Yoon Woo Woo Koh
- Department of Head and Neck Surgery and Otorhinolaryngology, Younsei University College of Medicine, Seoul, Korea the Republic of
| | - Eun Chang Chang Choi
- Department of Head and Neck Surgery and Otorhinolaryngology, Younsei University College of Medicine, Seoul, Korea the Republic of
| | - Luiz Paulo Kowalski
- Department of Head and Neck Surgery and Otorhinolaryngology, AC Camargo Cancer Center, São Paulo, SP, Brazil
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Robotic-assisted selective and modified radical neck dissection in head and neck cancer patients. Int J Surg 2015; 25:24-30. [PMID: 26602968 DOI: 10.1016/j.ijsu.2015.11.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 11/03/2015] [Accepted: 11/17/2015] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Recently, several authors introduced various methods and published feasibility studies on novel robotic-assisted neck dissection techniques for head and neck cancer patients. Cosmesis and general appearance have become important concerns of cancer patients today. Especially in the head and neck area, a conspicuous scar can reduce patient satisfaction after surgery. With conventional neck dissection techniques, a long scar in the neck is unavoidable. Therefore, the development of robotic assisted neck dissection provides the patients with a scarless neck in these situations. However, there are some limitations of the application of these techniques in their current stage of development. METHODS This study was performed using a systematic literature review. RESULTS The reviewed clinical studies show that robotic-assisted neck dissection yields similar functional and early oncologic outcomes to that of conventional neck dissection, as well as excellent cosmetic satisfaction of patients. Despite these benefits, some disadvantages can be observed, in terms of longer operation times as well as higher procedure costs. CONCLUSION Besides the similar oncologic and functional outcomes compared with the open procedure so far, more prospective, controlled, multicenter studies are required to establish robotic-assisted neck dissection as an alternative standard and to justify its added costs beyond the cosmetic advantages.
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Byeon HK, Koh YW. The new era of robotic neck surgery: The universal application of the retroauricular approach. J Surg Oncol 2015; 112:707-16. [DOI: 10.1002/jso.24019] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 08/08/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Hyung Kwon Byeon
- Department of Otorhinolaryngology; Yonsei University College of Medicine; Seoul Republic of Korea
| | - Yoon Woo Koh
- Department of Otorhinolaryngology; Yonsei University College of Medicine; Seoul Republic of Korea
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Albergotti WG, Byrd JK, Nance M, Choi EC, Koh YW, Kim S, Duvvuri U. Robot-Assisted Neck Dissection Through a Modified Facelift Incision. Ann Otol Rhinol Laryngol 2015; 125:123-9. [DOI: 10.1177/0003489415601127] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: 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. Study Design: Retrospective case series. Setting: University tertiary care hospital. Methods: 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. Results: 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. Conclusions: 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.
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Affiliation(s)
- William G. Albergotti
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - James K. Byrd
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Melonie Nance
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Veterans Affairs Pittsburgh Health System, Pittsburgh, Pennsylvania, USA
| | - Eun Chang Choi
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, South Korea
| | - Yoon Woo Koh
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, South Korea
| | - Seungwon Kim
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Umamaheswar Duvvuri
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Veterans Affairs Pittsburgh Health System, Pittsburgh, Pennsylvania, USA
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32
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Toppi JT, Bruscino-Raiola F. Modified radical neck dissection vs. selective neck dissection: an analysis of lymph node yield and post-surgical outcomes. EUROPEAN JOURNAL OF PLASTIC SURGERY 2015. [DOI: 10.1007/s00238-014-1054-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Endoscopic retroauricular thyroidectomy: preliminary results. Surg Endosc 2015; 30:355-65. [PMID: 25875088 DOI: 10.1007/s00464-015-4202-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 03/28/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSION Endoscopic RA thyroidectomy is technically feasible and safe with satisfactory cosmetic results for patients where indicated.
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Byeon H, Holsinger F, Kim D, Kim J, Park J, Koh Y, Choi E. Feasibility of robot-assisted neck dissection followed by transoral robotic surgery. Br J Oral Maxillofac Surg 2015; 53:68-73. [DOI: 10.1016/j.bjoms.2014.09.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 09/19/2014] [Indexed: 10/24/2022]
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36
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Greer Albergotti W, Kenneth Byrd J, De Almeida JR, Kim S, Duvvuri U. Robot-assisted level II-IV neck dissection through a modified facelift incision: initial North American experience. Int J Med Robot 2014; 10:391-6. [PMID: 24760419 DOI: 10.1002/rcs.1585] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Tae K, Ji YB, Song CM, Jeong JH, Cho SH, Lee SH. Robotic Selective Neck Dissection by a Postauricular Facelift Approach. Otolaryngol Head Neck Surg 2013; 150:394-400. [DOI: 10.1177/0194599813515431] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives The aim of this study was to investigate the feasibility and efficacy of robot-assisted neck dissection by a postauricular facelift approach in head and neck squamous cell carcinoma (HNSCC), compared with conventional neck dissection. Study Design Case series with chart review. Setting University tertiary care hospital. Subjects and Methods Thirty HNSCC patients with clinically node negative necks (cN0) who underwent robot-assisted selective neck dissection (SND) by a postauricular facelift approach (11 patients, 12 necks) or conventional neck dissection (19 patients, 21 necks). Results The mean age was lower in the robotic group ( P = .030). However, the distributions of gender and TNM stage did not differ between the two groups. The robotic SND was completed successfully in all patients. The mean operative time was longer in the robotic group (215 ± 56 min) than the conventional group (144 ± 43 min) ( P < .001). The mean numbers of lymph nodes removed were 25.0 ± 7.4 and 28.9 ± 8.2 in the robotic and conventional group, respectively ( P = .192), and the number of lymph nodes removed at each level also did not differ between the 2 groups. In addition, there was no significant difference in postoperative complications between the 2 groups, but cosmetic satisfaction was higher in the robot group ( P = .002). Conclusions Robot-assisted SND by a postauricular facelift approach is comparable to conventional neck dissection in selected patients with cN0 HNSCC and results in excellent postoperative cosmesis.
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Affiliation(s)
- Kyung Tae
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Yong Bae Ji
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Chang Myeon Song
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Jin Hyeok Jeong
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Seok Hyun Cho
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Seung Hwan Lee
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Korea
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38
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Abstract
As minimally invasive surgery has become common in head and neck surgery, the role of robotic surgery has expanded from thyroid surgery and transoral robotic surgery (TORS) of the oropharynx and supraglottic to other areas. Surgeons have advanced the limits of TORS, adapting lasers to the Da Vinci robot for glottic cancer, and combining existing techniques for transoral supraglottic laryngectomy and hypopharyngectomy to perform transoral total laryngectomy. Skull base approaches have been reported with some success in case reports and cadaver models, but the current instrument size and configuration limit the applicability of the current robotic system. Surgeons have reported reconstruction of the head and neck via local and free flaps. Using the previously reported approaches for thyroidectomy via modified facelift incision, neck dissection has also been reported. Future applications of robotic surgery in otolaryngology may be additionally expanded, as several new robotic technologies are under development for endolaryngeal work and neurotology.
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39
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Robot-assisted free flap in head and neck reconstruction. Arch Plast Surg 2013; 40:353-8. [PMID: 23898431 PMCID: PMC3723995 DOI: 10.5999/aps.2013.40.4.353] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 04/05/2013] [Accepted: 04/26/2013] [Indexed: 12/02/2022] Open
Abstract
Background Robots have allowed head and neck surgeons to extirpate oropharyngeal tumors safely without the need for lip-split incision or mandibulotomy. Using robots in oropharyngeal reconstruction is new but essential for oropharyngeal defects that result from robotic tumor excision. We report our experience with robotic free-flap reconstruction of head and neck defects to exemplify the necessity for robotic reconstruction. Methods We investigated head and neck cancer patients who underwent ablation surgery and free-flap reconstruction by robot. Between July 1, 2011 and March 31, 2012, 5 cases were performed and patient demographics, location of tumor, pathologic stage, reconstruction methods, flap size, recipient vessel, necessary pedicle length, and operation time were investigated. Results Among five free-flap reconstructions, four were radial forearm free flaps and one was an anterolateral thigh free-flap. Four flaps used the superior thyroid artery and one flap used a facial artery as the recipient vessel. The average pedicle length was 8.8 cm. Flap insetting and microanastomosis were achieved using a specially manufactured robotic instrument. The total operation time was 1,041.0 minutes (range, 814 to 1,132 minutes), and complications including flap necrosis, hematoma, and wound dehiscence did not occur. Conclusions This study demonstrates the clinically applicable use of robots in oropharyngeal reconstruction, especially using a free flap. A robot can assist the operator in insetting the flap at a deep portion of the oropharynx without the need to perform a traditional mandibulotomy. Robot-assisted reconstruction may substitute for existing surgical methods and is accepted as the most up-to-date method.
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