Robotic infraclavicular approach for minimally invasive neck dissection in head-neck cancers.

Background: In the recent years, there has been a rapid increase in the use of robot assisted neck dissection (RAND) as an alternative method for conventional neck dissection. Several recent reports have emphasized upon the feasibility and effectiveness of this technique. However, substantial technical and technological innovation is still essential in spite of the availability of multiple approaches for RAND. Materials and Methods: The present study describes a novel technique, i.e., Robotic Infraclavicular Approach for Minimally Invasive Neck Dissection (RIA MIND) used in head and neck cancers with the help of Intuitive da Vinci Xi Surgical System. Results: After RIA MIND procedure, the patient was discharged on the third post operative day. Also, the total wound size was less than 3.5 cm which enhanced the patient recovery time and required minimal post operative care. The patient was further reviewed 10 days after the procedure for the removal of sutures. Conclusion: RIA MIND technique was effective and safe for performing neck dissection for oral, head and neck cancers. However, additional detailed studies will be required for establishing this technique.

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.

Robotic-assisted breast-axillo insufflation thyroidectomy (RABIT): a retrospective case series of thyroid carcinoma.

OBJECTIVE: To evaluate the feasibility and safety of robotic-assisted breast-axillo insufflation thyroidectomy (RABIT) for differentiated thyroid cancer. METHODS: In this retrospective case series, patients with differentiated thyroid carcinoma were enrolled in our hospital from January 2018 to December 2018. All patients underwent indirect laryngoscopy to assess the status of vocal cord preoperatively. RABIT was performed with five separate breast-axillo incisions. All the procedures were performed using da Vinci Xi Robotic Surgical System, a single docking method using CO2 insufflation. RESULTS: Twelve patients completed RABIT, in which one case needed conversion to open thyroidectomy. The mean age was 30.25 ± 7 with male to female ratio being 1:1. Preoperative diagnosis showed papillary carcinoma (n = 9) and follicular neoplasm (n = 3). The mean operative time for RABIT was 140 ± 50.45 min and average blood loss during surgery was 22.92 ± 9 mL. Mean hospital stay was 4.42 ± 1.08 days. Final pathology confirmed classical papillary thyroid carcinoma (n = 10; 83.3%) and follicular variant of papillary carcinoma (n = 2; 16.7%). None of the cases reported injury or paralysis to the recurrent laryngeal nerves. CONCLUSION: RABIT is a safe and feasible approach for thyroidectomy. It has several advantages in that it provides similar symmetrical view to conventional open surgery and enables to maintain specimen integrity and use of assistant port permits better handling of the gland. Additionally, the largest operating angles with this technique prevent collision between the robotic arms and provide excellent cosmetic satisfaction due to very small, five separate breast-axillo incisions.