Robotic-assisted modified retroauricular cervical approach: initial experience in Latin America

Abstract

Objective: to evaluate the thickness of the gastric wall at the time of intra gastric balloon (IGB) placement, at the time of its withdrawal and one month after withdrawal. Methods: fifteen morbidly obese patients underwent the introduction of IGB under general anesthesia. In all patients, there was infusion of 500ml of distilled water in the balloon for the test. Measurements of the thickness of the gastric wall were made in the antrum, body and proximal body, using a radial echoendoscope with a frequency of 12MHz and maximum zoom, and its own balloon inflated with 5ml of distilled water. Results: the presence of IGB led to increased wall thickness of the gastric body by expanding the muscle layer. These changes were apparently transient, since 30 days after the balloon withdrawal there was a tendency to return of the wall thickness values observed before the balloon insertion. Conclusion: the use of intragastric balloon for the treatment of obesity determines transient increase in the wall thickness of the gastric body caused by expanded muscle layer.

Variations and results of retroauricular robotic thyroid surgery associated or not with neck dissection

“…Most of the experience with remote approaches to the thyroid come from Asia, especially South Korea (8,33), and most of the data published on robotic thyroid surgery explore the gasless transaxillary approach. The retroauricular or facelift approaches have gained attention more recently and, consequently, we find fewer publications analyzing it (3,6,7,16,21,22,(34)(35)(36)(37)(38)(39)(40)(41)(42)(43). Although composed mostly of initial series of cases, this growing body of evidence supports the safety and efficacy of the approach and shows that it has been performed for selected patients at several centers around the world, including some centers in US (7).…”

“…Since 2015 we have implemented robotic and endoscopic neck surgery via the retroauricular approach in our department, becoming pioneers in these techniques in South America (21)(22)(23)(24). In this early experience, we have performed mainly neck dissections for different pathologies, thyroid surgeries, and submandibular gland excisions, becoming the first center outside of Asia to perform thyroid surgery combined with lateral neck dissection using the robot-assisted retroauricular approach.…”

“…No significant setbacks have occurred, and now, with more than 160 procedures, safety and feasibility are no longer a question at our institution. Robotic neck surgery using the retroauricular approach proved to be very versatile and has been used for several different neck procedures, including neck dissections, benign tumors, and salivary gland resections, in addition to thyroid surgery (18,19,21,22,24,(45)(46)(47)(48)(49). The combination of thyroid surgery and lateral neck dissection of levels II-VI using this technique can avoid the extensive neck scar of conventional surgery in patients with lateral metastasis of thyroid carcinoma.…”

“…For both the robot-assisted thyroidectomy and SND, a retroauricular approach was performed as previously described by the Yonsei University in Seoul and subsequently reproduced at our department for different neck surgical procedures (21)(22)(23)(24). In summary, after positioning the patient, a skin incision was made behind the auricle from the lower end of the retroauricular sulcus upward to the midpoint of the sulcus, and then smoothly angulated downward approximately 0.5 cm inside the hairline (Figure 1).…”

“…In recent years, other American centers and some centers in other countries started to use robotic surgery for neck procedures, including thyroidectomy, especially via retroauricular incision (3,7,(21)(22)(23). The objective of this study is to report the initial experience of a tertiary center of oncology in robotic thyroidectomy, combined or not with neck dissection, performed by the retroauricular approach.…”