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Retroauricular Endoscope-Assisted Approach to the Neck: Early Experience in Latin America.

Lira RB, Chulam TC, Koh YW, Choi EC, Kowalski LP - Int Arch Otorhinolaryngol (2016)

Bottom Line: Introduction There has been a significant increase in concern towards improving aesthetic and functional outcomes without compromising the oncologic effectiveness in head and neck surgery.Objectives This study aims to provide a descriptive analysis of our initial experience with retroauricular endoscope-assisted approach assessing feasibility, safety, and aesthetic results.Conclusion Our initial experience has shown us that this approach is feasible, safe, oncologically efficient, and applicable to selected cases, with a clear cosmetic benefit.

View Article: PubMed Central - PubMed

Affiliation: Department of Head and Neck Surgery and Otorhinolaryngology, AC Camargo Cancer Center, São Paulo, SP, Brazil.

ABSTRACT
Introduction There has been a significant increase in concern towards improving aesthetic and functional outcomes without compromising the oncologic effectiveness in head and neck surgery. In this subset, endoscope-assisted and robotic procedures allowed the development of new approaches to the neck, including the retroauricular access, which is now routinely used, especially in Korea. Objectives This study aims to provide a descriptive analysis of our initial experience with retroauricular endoscope-assisted approach assessing feasibility, safety, and aesthetic results. Methods Prospective analysis of the first 11 eligible patients submitted to retroauricular endoscope-assisted approach for neck procedures in the Head and Neck Surgery Department at AC Camargo Cancer Center. Results A total of 18 patients were included in this study, comprising 7 supraomohyoid neck dissections, 8 submandibular gland excisions, 3 thyroid lobectomies, and one paraganglioma excision. There was no significant local complications, surgical accident, or need for conversion into conventional open procedure in this series. Conclusion Our initial experience has shown us that this approach is feasible, safe, oncologically efficient, and applicable to selected cases, with a clear cosmetic benefit.

No MeSH data available.


Related in: MedlinePlus

Retroauricular endoscopy-assisted SOHND. (A) Overview of workspace; (B) Removal of levels II and III; (C) SMG duct being divided; (D) Final aspect of surgical field.
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FI0334or-2: Retroauricular endoscopy-assisted SOHND. (A) Overview of workspace; (B) Removal of levels II and III; (C) SMG duct being divided; (D) Final aspect of surgical field.

Mentions: Patient preparation for surgery was the same as that which is typically used for other neck surgeries performed under general anesthesia. The patient was positioned at the operating table with cervical extension and contralateral head rotation. The surgeon performs the retroauricular incision (Fig. 1) and raises the subplatismal skin flap exposing the surgical field limited by neck midline, lower mandible border, omohyoid muscle, and esternocleidomastoid muscle, as described at Yonsei Medical Center Head and Neck Department in Seoul.151622 During flap elevation, it is important to identify and preserve the great auricular nerve and external jugular vein. Then, a Thompson self-retaining retractor (Thompson Surgical Instruments, Traverse City, U.S.A.) was applied establishing the proper working space. Neck dissection (Fig. 2), submandibular or neck mass excision was then performed with assistance of an ultrasonic scalpel (Ultracision ACE, Johnson & Johnson, U.S.A.), vascular clips (Hem-o-lock, Teleflex, Morrisville, U.S.A.), a 10mm, 30-degree endoscope, and usual laparoscopic instruments (Grasper and Maryland forceps). The surgeon performed any dissections lateral to the carotid artery under direct vision using headlights, albeit without magnification tools, and regular surgical instruments, before introducing the endoscope. Routine dissection and preservation of facial marginal branch, vagus, hypoglossus, lingual, accessory, and phrenic nerves were performed only for SOHND. Selective nerves were dissected and preserved for other the procedures, as needed. Closed aspirative drains (Blake, Ethicon Inc., Somerville, U.S.A.) were placed in all cases. The medical team discharged patients following the routine of the department for similar surgical procedures. All patients were followed at the Head and Neck Surgery outpatient clinic for a minimum of 30 days. At every post-operative visit, the surgeon evaluated the patients every post-operative visit for possible complications such as seroma, hematoma, surgical site infection, cranial nerve impairment, and skin flap dehiscence or necrosis. The frequency of these visits varied according to the surgical procedure performed and the patient's specific requirements. We also collected data regarding time to drain removal, which was performed when the drain output was less than 20 mL/day.


Retroauricular Endoscope-Assisted Approach to the Neck: Early Experience in Latin America.

Lira RB, Chulam TC, Koh YW, Choi EC, Kowalski LP - Int Arch Otorhinolaryngol (2016)

Retroauricular endoscopy-assisted SOHND. (A) Overview of workspace; (B) Removal of levels II and III; (C) SMG duct being divided; (D) Final aspect of surgical field.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4835336&req=5

FI0334or-2: Retroauricular endoscopy-assisted SOHND. (A) Overview of workspace; (B) Removal of levels II and III; (C) SMG duct being divided; (D) Final aspect of surgical field.
Mentions: Patient preparation for surgery was the same as that which is typically used for other neck surgeries performed under general anesthesia. The patient was positioned at the operating table with cervical extension and contralateral head rotation. The surgeon performs the retroauricular incision (Fig. 1) and raises the subplatismal skin flap exposing the surgical field limited by neck midline, lower mandible border, omohyoid muscle, and esternocleidomastoid muscle, as described at Yonsei Medical Center Head and Neck Department in Seoul.151622 During flap elevation, it is important to identify and preserve the great auricular nerve and external jugular vein. Then, a Thompson self-retaining retractor (Thompson Surgical Instruments, Traverse City, U.S.A.) was applied establishing the proper working space. Neck dissection (Fig. 2), submandibular or neck mass excision was then performed with assistance of an ultrasonic scalpel (Ultracision ACE, Johnson & Johnson, U.S.A.), vascular clips (Hem-o-lock, Teleflex, Morrisville, U.S.A.), a 10mm, 30-degree endoscope, and usual laparoscopic instruments (Grasper and Maryland forceps). The surgeon performed any dissections lateral to the carotid artery under direct vision using headlights, albeit without magnification tools, and regular surgical instruments, before introducing the endoscope. Routine dissection and preservation of facial marginal branch, vagus, hypoglossus, lingual, accessory, and phrenic nerves were performed only for SOHND. Selective nerves were dissected and preserved for other the procedures, as needed. Closed aspirative drains (Blake, Ethicon Inc., Somerville, U.S.A.) were placed in all cases. The medical team discharged patients following the routine of the department for similar surgical procedures. All patients were followed at the Head and Neck Surgery outpatient clinic for a minimum of 30 days. At every post-operative visit, the surgeon evaluated the patients every post-operative visit for possible complications such as seroma, hematoma, surgical site infection, cranial nerve impairment, and skin flap dehiscence or necrosis. The frequency of these visits varied according to the surgical procedure performed and the patient's specific requirements. We also collected data regarding time to drain removal, which was performed when the drain output was less than 20 mL/day.

Bottom Line: Introduction There has been a significant increase in concern towards improving aesthetic and functional outcomes without compromising the oncologic effectiveness in head and neck surgery.Objectives This study aims to provide a descriptive analysis of our initial experience with retroauricular endoscope-assisted approach assessing feasibility, safety, and aesthetic results.Conclusion Our initial experience has shown us that this approach is feasible, safe, oncologically efficient, and applicable to selected cases, with a clear cosmetic benefit.

View Article: PubMed Central - PubMed

Affiliation: Department of Head and Neck Surgery and Otorhinolaryngology, AC Camargo Cancer Center, São Paulo, SP, Brazil.

ABSTRACT
Introduction There has been a significant increase in concern towards improving aesthetic and functional outcomes without compromising the oncologic effectiveness in head and neck surgery. In this subset, endoscope-assisted and robotic procedures allowed the development of new approaches to the neck, including the retroauricular access, which is now routinely used, especially in Korea. Objectives This study aims to provide a descriptive analysis of our initial experience with retroauricular endoscope-assisted approach assessing feasibility, safety, and aesthetic results. Methods Prospective analysis of the first 11 eligible patients submitted to retroauricular endoscope-assisted approach for neck procedures in the Head and Neck Surgery Department at AC Camargo Cancer Center. Results A total of 18 patients were included in this study, comprising 7 supraomohyoid neck dissections, 8 submandibular gland excisions, 3 thyroid lobectomies, and one paraganglioma excision. There was no significant local complications, surgical accident, or need for conversion into conventional open procedure in this series. Conclusion Our initial experience has shown us that this approach is feasible, safe, oncologically efficient, and applicable to selected cases, with a clear cosmetic benefit.

No MeSH data available.


Related in: MedlinePlus