Remote access sentinel lymph node biopsy in oral cancer

Lymph node management in patients with oral squamous cell carcinoma (OSCC) has been subject to surgical de-escalation. Sentinel lymph node biopsy (SLNB), as established for other entities, has emerged as the standard of care for small OSCC. Moreover, remote access surgery in head and neck oncology, using both a retroauricular approach to the neck and robotic techniques, has evolved over the last several years. The combination of SLNB and remote access in selected cases offers minimally invasive neck management without impairment of oncological safety.

Endoscopic Neck Dissection and Intraoral Approach for Oral Cancer and Free Flap Reconstruction

This study aimed to report our experience about endoscopic neck dissection through a post-auricular hairline incision, followed by intraoral resection of oral cancer and free flap reconstruction. Laryngoscope, 135:130-133, 2025.

The Application of the NOSES System to Treat Cheek Squamous Cell Carcinoma

PURPOSE

Oral squamous cell carcinoma is one of the most common types of cancer in the head and neck. Squamous cell carcinoma of the buccal mucosa is an important part of it. The traditional surgical method leads to great injury and is accompanied by unacceptable scars. Previous improvements have been carried out in a single part. Natural orifice specimen extraction surgery (NOSES) system could perform "scarless surgery" and reduce complications. This technique was usually used for transvaginal or transanal specimen retrieval. There is great potential for oral and maxillofacial applications, especially in the field of oral and maxillofacial surgery. We combine the 2 to achieve better surgical results.

METHODS

The authors applied the NOSES system in the radical operation of buccal mucosa squamous cell carcinoma. Through FACE-LIFT incision, with the help of indocyanine green (ICG) and microscope, they successfully cured buccal mucosa squamous cell carcinoma.

RESULTS

The patient was cured, and there was no recurrence after 1 year of follow-up. The incision is hidden, and the damage is small. The number of harvested lymph nodes in the pathologic examination was 1/18.

CONCLUSIONS

The application of the NOSES system in maxillofacial surgery has very obvious advantages. The surgical procedures follow the principles of aseptic and tumor-free techniques, making the tumor en-block dissection. For stage 1 patients, this scheme not only ensures the radical cure of the tumor but also improves the detection rate of lymph nodes and ensures the patients' appearance. For doctors, this program is easy to operate and learn and can reduce the peer gap.

Comparisons of different approaches and incisions of thyroid surgery and selection strategy

To date, the traditional open thyroid surgery via a low collar incision remains the standard approach for patients undergoing thyroidectomy. However, this conventional approach will inevitably leave patients a neck scar and even cause a variety of complications such as paresthesia, hypesthesia, and other uncomfortable sensations. With the progress in surgical techniques, especially in endoscopic surgery, and the increasing desire for cosmetic and functional outcomes, various new approaches for thyroidectomy have been developed to avoid or decrease side effects. Some of these alternative approaches have obvious advantages compared with traditional surgery and have already been widely used in the treatment of thyroid disease, but each has its limitations. This review aims to evaluate and compare the different approaches to thyroidectomy to help surgeons make the proper treatment strategy for different individuals.

Efficacy and Safety of Novel Minimally Invasive Neck Dissection Techniques in Oral/Head and Neck Cancer: A Systematic Review and Meta-Analysis

Despite minimally invasive neck dissection (MIND) being popular technique, there is a paucity of literature emphasizing its safety and efficacy. In this meta-analysis, we compared the efficacy and safety of MIND over CND techniques in treating oral/head and neck cancer. We systematically searched PubMed, MEDLINE, Embase, from database inception to January, 2019 for the relevant studies comparing MIND and CND. Two independent reviewers performed quality check and data were extracted for primary outcomes to assess length of hospital stay, duration of surgery, intraoperative blood loss and retrieved lymph nodes. Drainage volume and duration, length of incision, satisfaction of scar and safety were the secondary outcomes. We analyzed the outcomes using standard mean differences (SMDs) and the relative risk that were pooled using random effect meta-analysis. Out of 144 studies, 17 met the final inclusion criteria. MIND technique has shown better overall efficacy with outcomes compared to CND except with duration of surgery (SMD 1.82, 95% CI 0.47-3.17). Lesser hospital stay, better nodal yield and less intra-operative blood loss was observed with MIND over CND. Duration and volume of wound drainage was comparably less in MIND with smaller length of incision. Postoperative complications were less and tolerable with MIND approach with superior cosmetic outcomes. MIND via endoscopic or robotic approach is safe and efficacious with equitable oncological outcomes in terms of lymph nodes yield compared to CND, but it requires longer surgery duration.

Endoscopic Cervical Lymph Node Dissection Using the Extra-cervical Anterior Chest Wall Approach: A New Technique

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.

VITOM-3D-assisted retroauricular neck surgery (RANS-3D): preliminary experience at Candiolo Cancer Institute

Objective

The recent introduction of 3D exoscopic surgery has engendered interesting technical improvements in head and neck surgery. The main goal of this study was to describe the application of 3D exoscopic technology on a wide range of pathologies of the neck, benign and malignant, through a minimally invasive retroauricular approach.

Methods

In the period January-December, 2019, 40 consecutive patients underwent neck surgery with a retroauricular approach, enhanced by using a 3D exoscope at the Head and Neck Oncological Unit of Candiolo Cancer Institute.

Results

Data regarding time to drain removal, length of hospitalisation, degree of pain experienced, need for opioid drugs during hospitalisation and after discharge, and intra-operative and post-operative complications were collected. All patients were followed for a minimum of 90 days with possible complications evaluated at each post-operative visit. Post-operative outcomes were evaluated at 3 months after surgery.

Conclusions

The current study indicates that VITOM-3D-assisted retroauricular neck surgery (RANS-3D) may be an interesting approach for neck surgery. The hybrid execution of neck dissection under direct and exoscopic vision represents a valid alternative to video-assisted endoscopic- and robot-assisted techniques.

Rhytidectomy approach for treatment of zygomatic arch fractures

Comminuted zygomatic arch fractures are a challenge to manage without complete exposure owing to their instability. The presence of facial nerve branches near the bone often means that these fractures are often treated by closed methods or left untreated. The disadvantages of such comminuted fracture left untreated cannot be overemphasised. Hence, there is a need of a surgical approach for exposure and fixation of such fractures without limitation of facial nerve injury. We propose and report a case of malunited comminuted fracture of zygomatic arch using facelift approach.

Comparing Technical Feasibility of Non-robotic Retroauricular Versus Transcervical Approach Neck Dissection in Oral Cancers-a Preliminary Single Institute Experience

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.

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

OBJECTIVE

Robot-assisted neck dissection requires a larger wound, is expensive and requires specialised equipment which is not easily available. We have developed an inexpensive minimally invasive neck dissection (MIND) procedure using simple endoscopic instruments in the past. This study was conducted to evaluate the safety, efficacy and reproducibility of the technique.

MATERIALS AND METHODS

From January 2013 to December 2016, we performed MIND on 45 patients with oral cancer using the standard endoscopic equipment. CO2 gas insufflation was used to create the working space. Intra-operative data, post-operative data and pathological characteristics were evaluated and overall survival (OS) and disease-free survival (DFS) Kaplan-Meier curves were compared using the Log-Rank test.

RESULTS

Median operative time was 130 (80-190) min with a mean blood loss of 63 (20-150) ml. Major intra-operative complications were not observed. The median number of nodes retrieved was 14 (range: 7-38). Three patients with a positive lymph node were advised to undergo adjuvant radiotherapy. After consultation, 12 out of 13 tongue cancer patients with a tumour depth >3 mm underwent adjuvant radiotherapy. Mean follow-up period was 31.5 (95% confidence interval [CI] 27.9-35.1) months and 27.8 (95% CI 23.6-32.1) months for OS and DFS, respectively. Four (8.9%) deaths and 8 (17.8%) recurrences were observed. The 3-year OS and DFS was 91.1% and 82.2%, respectively.

CONCLUSION

MIND is aesthetically better than conventional procedures for oral cancer patients due to its safety, efficacy and reproducibility at any centre using the standard laparoscopic equipment.

Comparison of retroauricular and small transcervical approaches for endoscopic-assisted selective neck dissection: a cadaveric study

Advances in endoscopic-assisted neck surgery have allowed surgeons to conceal the scars via various approaches. However, studies comparing the approaches are still rare. The aim of this study was to comparatively analyze the feasibility and oncological outcomes of the retroauricular approach (RA) and the small transcervical approach (STC) for endoscopic-assisted selective neck dissection (EASND). Five fresh cadavers were recruited. EASND was performed via RA on one side and via STC on the contralateral side of each of the cadavers. The duration of the procedure was subdivided into preparation and EASND, and was recorded during the operation. The preserved vital structures were inspected by another surgeon after the cadaver dissection. The total number of lymph nodes retrieved was assessed by a pathologist. There was no significant difference in lymph node count between the RA group (mean 21, range 9-38) and the STC group (mean 23, range 7-34) (P>0.05). The operation time was significantly longer in the RA group than in the STC group (preparation, P=0.042; EASND, P=0.043). In terms of surgical feasibility, STC can be chosen as the approach of choice for EASND. In spite of a long learning curve, RA might be an alternative option in particular cases to minimize scarring.

The Latest Advancements in Selective Neck Dissection for Early Stage Oral Squamous Cell Carcinoma

OPINION STATEMENT

The management of cervical lymph node metastasis remains a crucial component of the treatment of head and neck cancers. However, the proper management of clinical N ₀ cases with early-stage oral squamous cell carcinoma (OSCC) remains undefined. In the advent of minimally invasive techniques in the 1980s, these techniques have gained popularity among numerous surgeons in all fields of surgery. Although there are no randomized controlled trial data comparing the outcomes of minimally invasive techniques (endoscopically assisted selective neck dissection (SND), robot-assisted SND) with conventional techniques, encouraging evidence from several studies suggests that both endoscopically assisted SND and robot-assisted SND are safe, minimally invasive techniques with achieved short-term oncologic outcomes and can reach a better cosmetic outcome than conventional SND. In this review, we also compare the indications, surgical approaches, and relative advantages and disadvantages of conventional SND, endoscopically assisted SND, and robot-assisted SND to provide surgeons with a means to better consider these techniques for the treatment of early-stage OSCC.

Recent progress of retroauricular robotic thyroidectomy with the new surgical robotic system

OBJECTIVE

Previously, we have reported the feasibility of retroauricular (RA) robotic thyroidectomy. Despite its promising surgical outcomes, there were certain intrinsic mechanical limitations inherent to the da Vinci Si System (Intuitive Surgical, Sunnyvale, California, U.S.A.). Since the advent of an upgraded model, the Xi System (Intuitive Surgical), we have actively incorporated the new model into performing RA thyroidectomy. Here, we intend to verify the feasibility of RA robotic thyroidectomy using the new da Vinci Xi System (Intuitive Surgical) with comparison of the former Si-applied surgery (Intuitive Surgical).

STUDY DESIGN

Comparative analysis.

METHODS

There were total 165 consecutive patients who received RA robotic thyroidectomy from January 2013 to February 2016. The patients were divided into two groups: Si group (n = 125) and Xi group (n = 40). Perioperative and treatment outcomes were compared and analyzed.

RESULTS

Compared with the previous system, new da Vinci Xi system (Intuitive Surgical) enabled insertion of an extra third robotic instrumental arm. Unlike the previous robotic surgical technique, the robotic dissection could be initiated immediately after the establishment of working space and the resulting total operation time could be significantly decreased. There was no difference in the surgical completeness, as confirmed by postoperative thyroglobulin levels. Additionally, flexed EndoWrist (Intuitive Surgical) instruments equipped with the Erbe (Erbe USA Inc., Marietta, Georgia, U.S.A.) system could be mounted, which further facilitated the operation. There were no significant differences in postoperative complications between the two groups.

CONCLUSION

The RA robotic thyroidectomy with the new Xi System (Intuitive Surgical) can greatly facilitate the robotic surgery with comparable or improved surgical outcomes. Its application is expected to open up a new era of robotic neck surgery.

LEVEL OF EVIDENCE

4. Laryngoscope, 128:1730-1737, 2018.

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

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

Minimally Invasive Neck Dissection (MIND) Using Standard Laparoscopic Equipment: a Preliminary Report and Description of Technique

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.

Retroauricular Endoscope-Assisted Approach to the Neck: Early Experience in Latin America

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.

Minimally invasive supraomohyoid neck dissection by total endoscopic technique for oral squamous carcinoma

BACKGROUND AND OBJECTIVE

To study the feasibility of a total endoscopic technique for selective neck dissection in oral cancers and to compare the technique with conventional open technique with a long cervical scar.

METHODS

We included patients with early intraorally resectable squamous carcinomas and excluded patients whose primary lesion required reconstruction with microvascular flaps. We compared the following intraoperative parameters: cumulative length of the incision(s), duration of surgery, estimated blood loss, and intraoperative complications. The postoperative parameters included hospital stay, shoulder function, duration of analgesic use, and early postoperative complications. We used Shoulder Pain And Disability Index scores to assess shoulder function and assessed the oncologic outcome histopathologically by the number of nodes dissected.

RESULTS

The mean operative time for minimally invasive supraomohyoid neck dissection (MISOND) was 53.7 ± 29.8 min, which was significantly longer than 39.4 ± 5.0 min for the open technique. The estimated blood loss in the MISOND group was significantly lower compared with the open technique (p < 0.001), and there were no major intraoperative complications in either group. Postoperative recovery assessed by hospital stay and time to resume routine work was slightly shorter in the MISOND group but not statistically significant. There were no reported early postoperative complications such as haemorrhage, wound dehiscence, or chyle leakage in either group. The mean Shoulder Pain And Disability Index score assessed 2 weeks postoperatively for the MISOND group was 14.35 ± 0.71 %, which was significantly better than 44.14 ± 1.18 % for the open technique (p < 0.001). The number of nodes dissected showed no significant difference between groups.

CONCLUSIONS

MISOND is a feasible and safe procedure with immediate oncologic outcomes comparable with those of conventional open SOND and provides better cosmetic and functional outcomes.

Approaches of robot-assisted neck dissection for head and neck cancer: a review

Robot-assisted surgery is being increasingly used by surgeons because of its enhancement of visualization, precision, and articulation compared with conventional minimally invasive techniques. In recent years, robot-assisted neck dissection (RAND) has begun to be used as an alternative method of neck dissection, one of the classic surgical procedures in the area of head and neck surgery. Currently, there are four kinds of approaches for RAND: (1) modified facelift or retroauricular incision, (2) combined transaxillary and retroauricular incision, (3) transaxillary incision, and (4) transoral incision. RAND may help perform minimally invasive surgery and achieve excellent cosmetic results as well as the desired oncologic outcomes, and this requires selecting an appropriate approach based on the different needs of neck dissections. Although experienced surgeons wishing to avoid large cervical incisions in patients can safely perform RAND, there are still quite a few limitations; in particular, surgical morbidity and oncologic outcomes should be verified by further prospective clinical trials with longer follow-up periods. Also, RAND needs to be standardized and its use disseminated. In this review, we introduce the applications of different approaches for RAND and their indications and determine whether RAND can be more beneficial compared with conventional surgeries.

Comprehensive application of robotic retroauricular thyroidectomy: The evolution of robotic thyroidectomy

OBJECTIVES/HYPOTHESIS

As an evolvement of the robotic application to the thyroidectomy, we sought to seek the potential role of robotic thyroidectomy with the retroauricular (RA) approach prior to future comparative study between RA and transaxillary thyroidectomy. This study aims to verify the surgical feasibility of robotic RA thyroidectomy.

STUDY DESIGN

Case series with planned data collection.

METHODS

A total of 87 patients who underwent robotic RA thyroidectomy for clinically suspicious papillary thyroid carcinoma or benign lesions from January 2013 to May 2014 were retrospectively reviewed and analyzed.

RESULTS

All robotic surgeries via RA 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

Robotic RA thyroidectomy is technically feasible and safe, with satisfactory cosmetic results for patients where indicated.

LEVEL OF EVIDENCE

4. Laryngoscope, 126:1952-1957, 2016.

Reconstruction of the segmental mandibular defect using a retroauricular or modified face-lift incision with an intraoral approach in head and neck cancer

CONCLUSIONS

This is the first report of mandibular reconstruction using the retroauricular (RA) or the modified face-lift (MFL) approach in head and neck cancer. This approach may have advantages over the conventional approach, especially in its superior aesthetic results.

OBJECTIVE

The fibular osseous or osteocutaneous free flap is a widely accepted option for the reconstruction of mandibular defects. Recently, we devised an RA or an MFL approach for neck dissection (ND) using an endoscopic or robotic surgical system. Here, we performed the reconstruction of a segmental mandibular defect with a fibular free flap using the RA or the MFL approach.

METHODS

A total of five patients underwent mandibular reconstruction with the RA or MFL approach for mandibular discontinuity, which developed after the surgical extirpation of head and neck cancer. We performed ND, segmental mandibulectomy, and the reconstruction of the mandibular defect via RA or MFL incisions.

RESULTS

An osseous free flap was used for the reconstruction in two patients and the osteocutaneous free flap was used in three patients. The mean operation times for mandibulectomy and ND were 82 (range 45-120) min and 156 (range 140-180) min, respectively. No significant complications were noted. All flaps survived successfully.

Endoscopic retroauricular thyroidectomy: preliminary results

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.

Minimally invasive selective neck dissection: a prospective study of endoscopically assisted dissection via a small submandibular approach in cT(1-2_N(0) oral squamous cell carcinoma

BACKGROUND

Selective neck dissection (SND) in clinical N0 (cN0) cases of oral squamous cell carcinoma (SCC) has been performed by surgeons using a retroauricular or modified facelift approach with robotic or endoscopic assistance. However, these procedures provide cosmetic satisfaction at the cost of possible maximal invasiveness. In this prospective study, we introduced and evaluated the feasibility as well as surgical invasiveness and cosmetic outcome of endoscopically-assisted SND via a small submandibular approach.

METHODS

Forty-four patients with cT1-2N0 oral SCC (OSCC) were randomly divided into two groups of endoscopically-assisted SND and conventional SND. Perioperative and postoperative outcomes of patients were evaluated, including the length of the incision, operating time for neck dissection, estimated blood loss during the operation, amount and duration of drainage, total hospitalization period, total number of lymph nodes retrieved, satisfaction scores based on the cosmetic results, perioperative local complications, shoulder syndrome, and follow-up information.

RESULTS

The mean operation time in the endoscopically-assisted group (126.04 ± 12.67 min) was longer than that in the conventional group (75.67 ± 16.67 min). However, the mean length of the incision was 4.33 ± 0.76 cm in the endoscopically-assisted SND group, and the amount and duration of drainage, total hospital stay, postoperative shoulder pain score, and cosmetic outcomes were superior in the endoscopically-assisted SND group. Additionally, the retrieved lymph nodes and complications were comparable.

CONCLUSIONS

Endoscopically-assisted SND via a small submandibular approach had a longer operation time than the conventional approach. However, endoscopically-assisted SND was feasible and reliable while providing minimal invasiveness and satisfactory appearance.

Esthetic neck dissection using an endoscope via retroauricular incision: a report of two cases

Various surgical techniques, such as endoscopic surgery and robotic surgery, are developed to optimize the esthetic outcome even in operations for malignancy. A modified face-lift or retroauricular approach are used to minimize postoperative scarring. Recently, robot-assisted surgery is being done in various fields and considered as favorable treatment method by many surgeons. However its high cost is a nonnegligible fraction for many patients. On the other hand, endoscopic surgery, which is cheaper than robotic surgery, is minimally invasive with contentable neck dissection. Although it is a difficult technique for a beginner surgeon due to its limited operation view, we suppose it as an alternative method for robotic surgery. Herein, we report two cases of endoscopic neck dissection via retroauricular incision with a discussion regarding the pros and cons of endoscopic neck dissection.