Feasibility, Safety, Nodal yields and Learning curves in Retroauricular Robot/Endoscope Assisted Neck Dissection in the Management of Head and Neck Cancer

Head and neck cancer is one of the most common in India. There is an increasing incidence of oral cancer in young patients. Where the primary lesion is amenable to transoral resection for early cancer, young patients are concerned about cosmesis and would prefer a surgical approach that would avoid a visible scar in the neck. Robot/endoscope–assisted neck dissection by retroauricular approach was performed in a total of 28 patients of cN0 patients between June 2016 and December 2019. The duration of surgery, perioperative complications, number of lymph nodes retrieved, and cosmetic outcomes were analyzed. Robot- and endoscope-assisted neck dissections were done in 15 and 13 cases, respectively. The mean age of the cohort was 46.18 ± 9.68 years. Twenty-four patients had tongue cancer. Mean time for skin flap raising, docking, and robotic console use was 48.21 ± 7.48 min, 10 ± 3.16 min, and 176.67 ± 47.27 min, respectively. Mean neck dissection time from skin incision to skin closure was 231.79 ± 54.94 min for completing level I to IV neck dissection. The mean number of retrieved nodes was 33.69 ± 12.81. Majority of the patients were highly satisfied with their cosmetic outcomes. During a median follow-up of 19.5 months, 3 patients developed recurrence. Robot/ endoscope–assisted neck dissection was feasible and safe but took a longer time to perform. Nodal yields were adequate and better cosmetic outcomes were achieved.