Robot-assisted neck dissection through a modified facelift or retroauricular approach

Transoral robotic surgery (TORS) for oropharyngeal and laryngohypo-pharyngeal tumors is not only a functionally but also a cosmetically excellent approach. However, visible cervical scars for elective neck dissection (ND) or therapeutic ND cannot be avoided. In our experience, using the conventional neck dissection resulted in long neck scars in patients with high risk of nodal metastases. Robot-assisted neck dissection (RAND) through transaxillary approach in a well-differentiated thyroid carcinoma with lateral neck node metastasis was first reported. Complete ND of the upper neck including level I is frequently required in the surgical management of head and neck squamous cell carcinoma, so we hypothesized that a retroauricular approach could provide the surgical field required for upper ND. Initially, we developed robot-assisted selective ND through a transaxillary and retroauricular approach to hide an apparent scar and to remove lateral or posterior neck compartments after TORS in patients with pharyngeal carcinomas. From accumulation of additional experiences with RAND, we have recently attempted performing level IV and V as well as level I-III dissections through a modified facelift or retroauricular approach without an axillary incision in head and neck cancers.