Yonsei Med J.  2012 Jan;53(1):193-197. 10.3349/ymj.2012.53.1.193.

Gasless Transaxillary Robot-Assisted Neck Dissection: A Preclinical Feasibility Study in Four Cadavers

• Shin YS
• Hong HJ
• Koh YW
• Chung WY
• Lee HY
• Hong JM
• Hwang CS
• Chang JW
• Choi EC

• KMID: 1779706
• DOI: http://doi.org/10.3349/ymj.2012.53.1.193

Abstract

PURPOSE
We hypothesized that comprehensive neck dissection could be achieved via a gasless transaxillary approach using a robotic system. We intended to evaluate the accessibility of level I, IIB and VA nodes with transaxillary robot-assisted neck dissection of four cadavers.
MATERIALS AND METHODS
Transaxillary robotic neck dissection was performed in four cadavers through a 7-cm longitudinal incision at the anterior axilla and a 0.8-cm-sized incision in the chest wall.
RESULTS
We successfully performed neck dissection from level II to V in all four cadavers. However, dissection of levels IIB and VA, which lie on the cephalic portion of the spinal accessory nerve, was difficult. Vital structures, including the internal jugular vein, carotid artery, vagus nerve, phrenic nerve, superior thyroid artery and hypoglossal nerve, were successfully identified and preserved.
CONCLUSION
Our results demonstrate the feasibility of robot-assisted neck dissection using a transaxillary approach. We suggest that gasless, transaxillary robotic neck dissection is a promising technique for treating nodal metastasis in thyroid cancers or in selected squamous cell carcinomas of the head and neck. However, some modification of the approach might be needed when performing comprehensive neck dissections of all levels of the neck.

Keyword

Trans-axillary; robotic; neck dissection; cadaver; squamous cell carcinoma; endoscope

MeSH Terms

Cadaver
Endoscopy/instrumentation/methods
Feasibility Studies
Female
Head and Neck Neoplasms/*surgery
Humans
Male
Neck/blood supply/innervation/surgery
Neck Dissection/*instrumentation/*methods
Neoplasms, Squamous Cell/*surgery
Robotics/*methods
Thyroid Neoplasms/*surgery

Figure

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  Fig. 1 Position and neck incision. With a cadaver placed in the supine position, the neck was slightly extended, and the dissection-side arm was abducted 45° and fixed; a 7 cm longitudinal skin incision along the anterior axillary line was made, and a second skin incision (0.8 cm long) was made on the medial side of the anterior chest wall.

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  Fig. 2 Surgical view. SAN, spinal accessory nerve; BP, brachial plexus; CA, carotid artery.

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  Fig. 3 Surgical view. TCA, transverse cervical artery; IJV, internal jugular vein, CA, carotid artery.

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  Fig. 4 Surgical view. STA, superior thyroid artery; digastric muscle, posterior belly of the digastric muscle; CA, carotid artery; IJV, internal jugular vein; SH, sternohyoid muscle.

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  Fig. 5 The axis of robotic system (A) for level III, IV, V dissection; (B) for level II dissection.

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