Feasibility of transoral robotic selective neck dissection with or without a postauricular incision for papillary thyroid carcinoma: A pilot study

Abstract

BackgroundThe study aimed to evaluate the feasibility of transoral robotic selective neck dissection (SND) with or without a postauricular incision for papillary thyroid carcinoma (PTC).MethodsWe studied 14 patients with PTC who underwent robotic SND via the transoral or combined transoral and postauricular approaches.ResultsThe transoral approach was performed on 10 patients for dissection of levels III and IV. An additional postauricular incision was made on 4 patients for dissection of level II in addition to levels III, IV, and V. The operation was completed successfully in 13 patients, except 1 patient with the procedure conversion due to uncontrolled bleeding from the internal jugular vein. The mean numbers of removed lymph nodes in the lateral compartment were 23.1 ± 9.4 and 38.3 ± 8.5 in the transoral and combined groups. Transient recurrent laryngeal nerve palsy occurred in 1 patient, transient hypoparathyroidism in 3 patients, and chyle leakage in 1 patient. There were no hematomas, mental nerve injuries, surgical space infections, or CO2 embolisms.ConclusionTransoral robotic SND is feasible with or without a postauricular incision.

A scoping review of endoscopic and robotic techniques for lateral neck dissection in thyroid cancer

“…Robotic transoral thyroidectomy has also gained traction, although there are not many studies detailing LND via this approach. Tae et al published a case report and case series of 14 patients (Table 4) (47,49). In both studies, there were the standard three incisions in the oral vestibule, one 1.5-2cm in the midline near the frenulum and additional ports on either side laterally, close to the oral commissure (Figure 3), with standard access and initial creation of the subplastysmal space (47).…”

“…After total thyroidectomy and CND, SLND of level III-IV is performed in the standard fashion with preservation of the phrenic nerve, cervical roots, and transverse cervical artery. In the case series, if there were suspicious nodes in Vb, these were also dissected via the three vestibular incisions; however, 4 patients had suspected LNM in level II and required the addition of a gasless retroauricular approach ( 49 ). This incision is made in the postauricular sulcus and extends to the hairline in the occiput ( Figure 6 ).…”

“…This incision is made in the postauricular sulcus and extends to the hairline in the occiput ( Figure 6 ). The flap is created over the SCM under direct vision using electrocautery, until it connects with the prior surgical field, and the robot is docked with the camera and two working ports placed through the retroauricular incision ( 49 ). The working space is maintained via an external retractor through the retroauricular incision and level II is dissected robotically.…”

“…Indications for this approach included PTC with LNM in level II-V. Contraindications included a history of neck surgery or radiation, large fused LNM, extensive invasion of surrounding structures, recurrent disease, distant metastases, or extensive multi-level LNM ( 47 , 49 ).…”

“…Mean operative time for the case series was 299 minutes for the transoral group and 431 minutes for the combined transoral and retroauricular approach. Thirteen patients underwent total thyroidectomy, CND, and SLND, while one patient had a lobectomy, CND, and SLND ( 49 ). One case was not completed via the transoral route but was converted to the retroauricular approach for uncontrolled IJV bleeding.…”