Submandibular gland resection via the trans‐hairline approach: A preclinical study of a novel flexible single‐port surgical system and the surgical experiences of standard multiarm robotic surgical systems

Abstract

Background: Cosmetic outcome after submandibular gland (SMG) surgery has greatly improved since the development of robotic surgery through a trans-hairline approach. However, the bulky sizes of robotic arms and the rigid design of camera and instruments in the current multiarm robotic systems increased the surgical difficulty. Methods: Clinical and preclinical studies demonstrated the surgical configuration and procedures of robotic trans-hairline SMG resection using a flexible, singleport, and multiarm systems. Results: The surgical procedures of trans-hairline approach for SMG resection could be successfully performed using the flexible single-port (SP) robotic system in the preclinical study. The unique features include an easier docking procedure, different viewing angles, the use of the third arm, and coordination of instrument positions without a bedside assistant, which are unavailable in current multiarm robotic systems. Conclusions: This study demonstrates the feasibility and the advantages of applying the flexible, SP robotic system in SMG resection through the trans-hairline approach. K E Y W O R D Scosmesis, flexible single-port robotic system, robotic surgery, submandibular gland, trans-hairline

Cervical lymphatic malformations amenable to transhairline robotic surgical excision in children

“…Additionally, transhairline incisions can also be converted to other incision types, such as RAHIs or retroauricular, transcervical, or combined with supraclavicular incisions, as required due to the anatomical locations of lesions. [ 33 ] Therefore, preoperative imaging studies are crucial for planning suitable docking access and surgical routes and predicting critical points concerning vital structures. Salvage plans should be prepared beforehand and improvised if the surgical team members observe that they cannot proceed with the robotic surgery.…”

Submandibular gland excision: From external surgery to robotic intraoral and extraoral approaches

“…In these cases, video‐assisted techniques, submental and retroauricular incisions and intraoral approaches appear contraindicated although particular attention should be done in the near future to the oncological results of the robot‐assisted dissection of the submandibular gland and the neck through the modified postauricular facelift approach (Lee et al, 2014). In this regard, the initial preclinical study with the novel flexible single‐port surgical robotic system to remove the submandibular gland via the transhairline approach is welcome (Yang et al, 2019).…”

“…This procedure implies the use of angled endoscope (30°-45°) and ultrasonic scalpel, two instruments providing magnification of the surgical field and excellent haemostasis. Yang reported on a series of 24 patients (11 pleomorphic adenoma, 12 sialolithiasis, one malignancy) undergoing robotic sialoadenectomy via a transhairline approach (Yang, 2018;Yang, Li, Holsinger, & Koh, 2019). This specific incision was already proposed by Woo, Park, Kwon, and Kim (2017) surgery and no recurrences are reported in the paper.…”

“…Yang reported on a series of 24 patients (11 pleomorphic adenoma, 12 sialolithiasis, one malignancy) undergoing robotic sialoadenectomy via a transhairline approach (Yang, 2018; Yang, Li, Holsinger, & Koh, 2019). This specific incision was already proposed by Woo, Park, Kwon, and Kim (2017) for their endoscope‐assisted technique showing its feasibility.…”

“…These authors however underline that the restricted working space obtained with transhairline approach appears not indicated for submandibular gland lesions with large sizes or severe adhesion. The series include also a patient affected by adenoid cystic carcinoma, successfully treated with a margin‐free surgery (Yang, 2018; Yang et al, 2019).…”