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Kim H, Cha IH, Kim HJ, Nam W, Yang H, Cho SU, Koh YW, Kim D. Comparing Free-Flap Reconstruction After Robot-Assisted Neck Dissection via a Retroauricular Approach and a Traditional Transcervical Approach: Single-Surgeon Experiences of 90 Consecutive Cases. Ann Surg Oncol 2023; 30:2554-2561. [PMID: 36520236 DOI: 10.1245/s10434-022-12904-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/16/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Predominant traditional approaches for most patients who have advanced-stage oral cancer with transcervical incision lines left irreversible scars. To address this, surgeons have continuously refined minimally invasive surgery (MIS) techniques, including robot-assisted neck surgeries. This article introduces and discusses the feasibility, versatility, and availability of free-flap reconstruction via the retroauricular approach (RA), considered difficult to date. METHODS This study retrospectively analyzed 90 consecutive patients who had free-flap reconstruction performed by a single surgeon (D.K.) in the Department of Oral and Maxillofacial Surgery, Yonsei University, from March 2021 to April 2022. The type of defects and flaps, hospitalization days, total operation time, and type of vessels and anastomoses were compared statistically. RESULTS The type of vessels used did not differ between the RA and the transcervical approach (TA) groups, nor in duration of hospital stays. Likewise, the total reconstruction time did not differ significantly between the TA group (240 min) and the RA group (245 min) (p = 0.756). However, the total operation time was about 1 h less in the TA group, a statistically significant difference (TA group [593 ± 152 min] vs. RA group [655 ± 117 min]; p = 0.044). All flaps were successful in the RA group, whereas one flap in the TA group led to a total loss (TA group [98.3%] vs. RA group [100.0%]; p = 1.000). CONCLUSIONS Even for patients with advanced oral cancer who require massive tumor ablation, it is feasible to obtain an aesthetic and functional surgical outcome by performing free-flap reconstruction via the retroauricular approach.
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Affiliation(s)
- Hyounmin Kim
- Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, Korea
| | - In-Ho Cha
- Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, Korea
| | - Hyung Jun Kim
- Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, Korea
| | - Woong Nam
- Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, Korea
| | - Hyunwoo Yang
- Department of Oral and Maxillofacial Surgery, Yongin Severance Hospital, Yongin, Korea
| | - Sung-Uk Cho
- Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, Korea
| | - Yoon Woo Koh
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea.
| | - Dongwook Kim
- Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, Korea.
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Wan WD, Lu C, yuan YX, Hu JJ, Liang J, He CY, Huang YQ, Su T, Guo F, Jiang CH, Li N. Lateral approach is a more aesthetical option for radical resection of BSCC: assessment of its surgical, oncological, functional, and aesthetic outcomes. BMC Oral Health 2022; 22:464. [PMID: 36329463 PMCID: PMC9632109 DOI: 10.1186/s12903-022-02519-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 10/13/2022] [Indexed: 11/05/2022] Open
Abstract
Background The purpose of this study was to introduce a modified lateral approach for combined radical resection of buccal squamous cell carcinoma (BSCC) and evaluate its surgical, oncological, functional, and aesthetic outcomes in comparison with the conventional lower-lip splitting approach. Methods This single-center study retrospectively reviewed 80 patients with BSCC, of which 37 underwent the lateral approach and 43 underwent the conventional approach. Surgical, functional, oncological, and aesthetic evaluations, as well as follow-ups, were recorded and compared. Results Compared to the conventional approach group, the lateral approach group had a longer surgical time (P = 0.000), but there was no significant difference in other surgical and oncological parameters. Moreover, the scar in the head and neck had a significantly discreet appearance in the lateral approach group, whose satisfaction was better than those in the conventional approach group (P = 0.000). Other oral function parameters, postoperative mouth-opening, and 3-year survival rate were not significantly different between the two groups. Conclusion The lateral approach could provide superior aesthetic results while maintaining equal surgical, functional, and oncological outcomes compared to the conventional approach for radical resection of BSCC. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-022-02519-1.
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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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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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Minimization of Radial Forearm Flap Donor-Site Scar Using Endoscopy and Allogeneic Dermal Matrix. J Oral Maxillofac Surg 2018; 76:1825.e1-1825.e3. [PMID: 29709407 DOI: 10.1016/j.joms.2018.03.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 03/29/2018] [Accepted: 03/29/2018] [Indexed: 11/23/2022]
Abstract
Radial forearm free flaps are widely used for soft tissue reconstruction in the oral cavity. However, preparation of the vascular pedicle leaves long undesirable scars. Extensive scar formation also occurs at the skin defect site. Over recent years, endoscopic surgery has been increasingly used for minimally invasive procedures. We report 4 cases involving the formation of radial forearm free flaps using endoscopy and an alloplastic skin graft, resulting in minimal scar formation and favorable results.
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Jung SW, Kim YK, Cha YH, Koh YW, Nam W. Robot-assisted submandibular gland excision via modified facelift incision. Maxillofac Plast Reconstr Surg 2017; 39:25. [PMID: 28944219 PMCID: PMC5583136 DOI: 10.1186/s40902-017-0122-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 07/12/2017] [Indexed: 11/25/2022] Open
Abstract
Background The conventional transcervical resection for submandibular gland disease has some risks and an unsatisfactory cosmetic result. Recently, robot-assisted surgery has been developed as a plausible substitute for conventional surgery which provides an excellent cosmetic outcome. Case presentation The authors performed robot-assisted sialadenectomy via modified facelift incision using the da Vinci Xi surgical system (Intuitive Surgical Inc., CA, USA) with two endowrist arms (monopolar curved scissors and Maryland bipolar forceps) successfully in a 44-year-old female patient who suffered from sialolith and severe atrophic submandibular gland. Conclusions If similar studies are done in the future, this robot-assisted sialadenectomy may become established as an alternative to existing disadvantageous surgical methods.
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Affiliation(s)
- Seung Wook Jung
- Department of Oral and Maxillofacial Surgery, Yonsei University, College of Dentistry, Seoul, Korea
| | - Young Kwan Kim
- Department of Oral and Maxillofacial Surgery, Yonsei University, College of Dentistry, Seoul, Korea
| | - Yong Hoon Cha
- Department of Oral and Maxillofacial Surgery, Yonsei University, College of Dentistry, Seoul, Korea
| | - Yoon Woo Koh
- Department of Otorhinolaryngology, Yonsei University, College of Medicine, Seoul, Korea
| | - Woong Nam
- Department of Oral and Maxillofacial Surgery, Yonsei University, College of Dentistry, Seoul, Korea
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Minimally Invasive Neck Dissection (MIND) Using Standard Laparoscopic Equipment: a Preliminary Report and Description of Technique. Indian J Surg Oncol 2017; 8:217-221. [PMID: 28546725 DOI: 10.1007/s13193-015-0474-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 10/04/2015] [Indexed: 10/22/2022] Open
Abstract
Neck dissection leaves behind an aesthetically unacceptable scar over front of the neck. Various techniques, both endoscopic and robotic, have been tried to avoid this scar. Though comparatively more cases of robotic surgery are reported than endoscopic neck dissection, the cost and availability of robot precludes many patients from getting the benefit of minimally invasive neck dissection (MIND). We performed minimally invasive neck dissection for two carefully selected patients with early oral cancer and cN0. We used standard endoscopic equipment and ubiquitously available laparoscopic ports. We used gas insufflation to create the working space. Our results show that MIND is feasible and oncologically safe. The scars produced are aesthetically better than that of conventional open neck dissection. This procedure leaves no scars in the anterior aspect of the neck. This technique can be replicated at any center with endoscopic equipments without need for purchasing specialised retractors or a robot.
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Kim JY, Kim WS, Choi EC, Nam W. The Role of Virtual Surgical Planning in the Era of Robotic Surgery. Yonsei Med J 2016; 57:265-8. [PMID: 26632411 PMCID: PMC4696964 DOI: 10.3349/ymj.2016.57.1.265] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 01/19/2015] [Accepted: 02/06/2015] [Indexed: 11/27/2022] Open
Abstract
Among various surgical methods introduced to optimize esthetic results, robotic surgery has gradually expanded in scope. As incision, approach, and operation view in robotic surgery differ from existing surgical methods, we should consider reconstruction from a different perspective. We recently experienced two mandibular reconstruction cases after tumor ablative surgery with robotic neck dissection using the conventional reconstruction method and virtual surgical planning (VSP), respectively. We found that the conventional reconstruction method is inappropriate in modified facelift incision in robotic neck dissection because it provides limited surgical scope, restricts access to the defect area, and therefore, consumes considerable time before anastomosis. For these reasons, the authors consider VSP far more viable in the era of robotic surgery.
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Affiliation(s)
- Jae Young Kim
- Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, Korea
| | - Won Shik Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Chang Choi
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea.
| | - Woong Nam
- Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, Korea
- Oral Cancer Research Institute, Yonsei University College of Dentistry, Seoul, Korea.
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