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

Lira, Renan Bezerra; Chulam, Thiago Celestino; Koh, Yoon Woo; Choi, Eun Chang; Kowalski, Luiz Paulo

doi:10.1055/s-0036-1578807

Cited by 22 publications

(11 citation statements)

References 30 publications

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“…Although these access routes cannot be literally defined as "minimally invasive", they are not burdened by the impact of the scar, which is virtually invisible and not a decisive factor in the main sequelae of the standard cervical approach; they can therefore be equated as outcomes with currently minimally invasive interventions, referring to them as "remote access" interventions. Concerning endoscopic-assisted neck dissection, several drawbacks have been highlighted by many studies [14][15][16][17] . These limitations include a reduced range of motion, with various collisions between first surgeon and assistant, a two-dimensional view with a lack of depth perception, impaired eye-hand coordination, minimal tactile sensation, and a relatively slow learning curve.…”

Section: Discussionmentioning

confidence: 99%

VITOM-3D assisted neck dissection via a retroauricular approach (RAND-3D): a preclinical investigation in a cadaver lab

Crosetti

Arrigoni

Manca

et al. 2020

Acta Otorhinolaryngol Ital

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SUMMARY Objective The recent introduction of 3D exoscopic surgery has allowed interesting technical improvements in head and neck surgery resulting in technical solutions that are also applicable to neck dissection. The aim is to replace robotic surgery while minimising the costs of the procedure. Methods Based on these considerations, we conducted a preclinical investigation in the cadaver lab focused on approaching conventional neck dissection using a retroauricular incision, and evalute the applications and usefulness of the Storz 3D Exoscopic System at different stages of the surgical procedure. The acronym RAND-3D (3D exoscopic surgery) was coined to describe the application of this optical tool in neck dissection. Results The current study in the cadaver lab indicates that RAND-3D is an acceptable alternative operating technique in performing neck dissection by a retroauricular approach. Technically feasible and safe, this technique assures a complete compartment-oriented dissection without damaging major vascular or nervous structures. Conclusions This approach can be used in selected cases with a clear cosmetic benefit and represents a valid alternative to endoscopic- and robotic-assisted neck dissection.

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Section: Discussionmentioning

confidence: 99%

VITOM-3D assisted neck dissection via a retroauricular approach (RAND-3D): a preclinical investigation in a cadaver lab

Crosetti

Arrigoni

Manca

et al. 2020

Acta Otorhinolaryngol Ital

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“…The final histopathological examinations confirmed the preoperative diagnosis and oncologic safety margins were free of tumor in all cases of tumors. Lira et al reported PA as first indication (3/8), followed by sialadenitis (2/8), and confirmed the use of this approach in one case of malignant tumor diagnosed as cribiform ACC 23 . Neves et al reported also PA as first indication (53%), followed by sialadenitis (31%), and confirmed the use of this approach in 4 cases of malignant tumors (16%), especially 1 case of ACC, 2 cases of mucoepidermoid carcinoma, and 1 case of oncocytic carcinoma, which were all resected with free oncologic safety margins 11 .…”

Section: Discussionmentioning

confidence: 77%

“…12 In contrast, Neves et al reported male predominance (61%) among 23 cases of endoscope-assisted retroauricular approach for SMG resection, with a mean age of 44.1 years; 11 Lira et al reported no sex predominance among 8 cases of endoscopic SMG excision via retro-auricular hairline incision. 23 Endoscopic SMG excision through hairline approach offers several advantages, including its feasibility, the reduced tissue damage, improved cosmetics as scar is hidden by the auricle and hair; lower risk of perioperative complications such as bleeding, infection, and temporary or permanent nerves (marginal mandibular, lingual, or hypoglossal) damages; more rapid wound healing and early recovery; and less postoperative pain. 3,4,6,8,9,11,12,19,21,23 The magnification of the surgical field, which allows good visualization and illumination of the anatomical landmark and structures is one of the great advantages of endoscopic surgery as it facilitates careful dissection of these anatomic structures, making the procedure very safe.…”

Section: Discussionmentioning

confidence: 99%

“…Sometimes it may be difficult to manipulate the instruments in this narrow space with possibility of collisions between the main operator and the assistant. 23 Endoscopic surgery instruments should be used carefully and any improper traction must be avoided because of the high risk of bleeding and nerves damage. 12,15,19 Although the dissection of the SMG is usually performed with the ultrasonic scalpel for the most part of the procedure, bipolar or monopolar electrocautery may be also used, especially during the creation of working space and skin flap elevation.…”

Section: Discussionmentioning

confidence: 99%

“…23 Endoscopic SMG excision through hairline approach offers several advantages, including its feasibility, the reduced tissue damage, improved cosmetics as scar is hidden by the auricle and hair; lower risk of perioperative complications such as bleeding, infection, and temporary or permanent nerves (marginal mandibular, lingual, or hypoglossal) damages; more rapid wound healing and early recovery; and less postoperative pain. 3,4,6,8,9,11,12,19,21,23 The magnification of the surgical field, which allows good visualization and illumination of the anatomical landmark and structures is one of the great advantages of endoscopic surgery as it facilitates careful dissection of these anatomic structures, making the procedure very safe. 2,4,5,[8][9][10][11]19 Nevertheless, the view of structures can be confusing at the beginning of one's experience.…”

Section: Discussionmentioning

confidence: 99%

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Gasless Endoscopic Submandibular Gland Excision Through Hairline Approach

Yang

Alkebsi

Chen

et al. 2023

Journal of Craniofacial Surgery

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Background: The aim of this study was to evaluate the therapeutic effect of gasless endoscopic submandibular gland excision through hairline approach and the safety, feasibility and practicability of this technique. Methods: Twenty-five patients with submandibular gland lesions who underwent gasless endoscopic submandibular gland excision through hairline approach at the Department of Head and Neck Oncology of the West China Hospital of Stomatology from May 1 st 2021 to May 31 st 2022 were included in this prospective study. The variables were analyzed statistically with SPSS software version 23.0 (IBM Corp, Armonk, New York, USA). Results: There was a female predominance (72%), female to male ratio was 2.6. The mean age was 30.6 ± 10.2 years (range: 11 to 52 year). All 25 cases of endoscopic submandibular gland excision through hairline approach were done without conversion to conventional approach. This approach was indicated in 14 cases (56%) for pleomorphic adenoma, 8 cases (32%) for chronic sialadenitis, 2 cases (8%) for adenoid cystic carcinoma, and 1 case (4%) for lymphadenitis. The incision length mean was 4.8 ± 0.4 mm (range: 4 to 5 mm); the operation duration mean was 100.6 ± 39.7 min (range: 51 to 197 min); the intraoperative bleeding mean was 13.2 ± 5.7 ml (range: 5 to 20 ml); the hospital length of stay mean was 4.5 ± 0.8 days (range: 3 to 6 days). The follow-up mean was 10 ± 3.4 months (range: 5 to 16 months). The patients were very satisfied with postoperative cosmetic result (score mean: 9.2 ± 1). No recurrence of disease and complications such as postoperative bleeding, hematoma, nerve damage, skin necrosis, infection, and hair loss occurred. Conclusions: Gasless endoscopic submandibular gland excision through hairline approach is safe, feasible and practicable, resulting in a very satisfied cosmetic result without significant complications; the intraoperative bleeding is less, the operative field is clear, the operation duration decreases with accumulation of experience.

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Anatomy, technique, and results of robotic retroauricular approach to neck dissection

Kowalski

Lira

2021

The Anatomical Record

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In the attempt to improve the cosmetic and functional outcomes in head and neck surgeries, robotic or video-assisted neck dissection using remote access has gained ground in recent years. Retroauricular approach emerged as the most versatile option, allowing proper dissection at all neck levels. In this technique, after retroauricular incision, a skin flap is elevated and a self-retaining retractor is placed, creating working space for the robotic, or endoscopic neck dissection. Numerous published series have shown the safety and favorable outcomes of retroauricular robotic neck dissections, without any major complications or surgery-related deaths. The only consistently reported disadvantage is a longer operative time. Our group has an experience of 190 retroauricular neck dissections performed over the last 5 years, without any major setbacks. The oncologic and safety outcomes have been comparable to the conventional technique, with clearly superior aesthetic results. In the process of expansion of Robotic Surgery in Brazil, our center is currently providing training and proctoring to capacitate other head and neck surgeons, and enable other centers to offer this surgical modality.

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

Cited by 22 publications

References 30 publications

VITOM-3D assisted neck dissection via a retroauricular approach (RAND-3D): a preclinical investigation in a cadaver lab

VITOM-3D assisted neck dissection via a retroauricular approach (RAND-3D): a preclinical investigation in a cadaver lab

Gasless Endoscopic Submandibular Gland Excision Through Hairline Approach

Anatomy, technique, and results of robotic retroauricular approach to neck dissection

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