Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Oct;40(5):343-351.
doi: 10.14639/0392-100X-N0757.

VITOM-3D assisted neck dissection via a retroauricular approach (RAND-3D): a preclinical investigation in a cadaver lab

Affiliations

VITOM-3D assisted neck dissection via a retroauricular approach (RAND-3D): a preclinical investigation in a cadaver lab

Erika Crosetti et al. Acta Otorhinolaryngol Ital. 2020 Oct.

Abstract

Objective: The recent introduction of 3D exoscopic surgery has allowed interesting technical improvements in head and neck surgery resulting in technical solutions that are also applicable to neck dissection. The aim is to replace robotic surgery while minimising the costs of the procedure.

Methods: Based on these considerations, we conducted a preclinical investigation in the cadaver lab focused on approaching conventional neck dissection using a retroauricular incision, and evalute the applications and usefulness of the Storz 3D Exoscopic System at different stages of the surgical procedure. The acronym RAND-3D (3D exoscopic surgery) was coined to describe the application of this optical tool in neck dissection.

Results: The current study in the cadaver lab indicates that RAND-3D is an acceptable alternative operating technique in performing neck dissection by a retroauricular approach. Technically feasible and safe, this technique assures a complete compartment-oriented dissection without damaging major vascular or nervous structures.

Conclusions: This approach can be used in selected cases with a clear cosmetic benefit and represents a valid alternative to endoscopic- and robotic-assisted neck dissection.

Dissezione laterocervicale mediante approccio retroauricolare assistito da sistema VITOM-3D (RAND-3D): studio preclinico in cadaver lab.

Obiettivo: Il recente avvento della chirurgia esoscopica 3D ha consentito, nell’ambito della chirurgia cervico-cefalica, l’introduzione di interessanti innovazioni tecnologiche, risultanti in soluzioni tecniche applicabili anche alla chirurgia del collo, con l’obiettivo di rappresentare un’alternativa alla chirurgia robotica, minimizzando i costi della procedura.

Metodi: Sulla base di queste considerazioni abbiamo recentemente condotto uno studio pre-clinico nel nostro cadaver lab, focalizzato sull’esecuzione dello svuotamento linfonodale laterocervicale con approccio retroauricolare, valutando le applicazioni e l’utilità del Sistema Esoscopico 3D Storz nei vari steps dell’intervento. Abbiamo coniato l’acronimo di RAND-3D (chirurgia esoscopica 3D) per descrivere l’impiego di questo tool ottico nell’esecuzione di tale procedura chirurgica.

Risultati: Il seguente studio condotto nel cadaver lab ha indicato che la tecnica RAND-3D rappresenta una valida alternativa per l’esecuzione dello svuotamento del collo con approccio retroauricolare. Questa metodica, tecnicamente fattibile e sicura, permette una dissezione compartimentale, senza danno alle principali strutture vascolo-nervose cervicali.

Conclusioni: Questo approccio può essere impiegato in casi selezionati con un chiaro finalismo estetico, rappresentando una valida alternativa alle metodiche endoscopiche e robotiche.

Keywords: 3D; 3D surgery; exoscope; neck dissection.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
A) Schematic of operating lab setting. B) Operating lab setting.
Figure 2.
Figure 2.
Modified retroauricular or facelift skin incision (red line).
Figure 3.
Figure 3.
Surgical view (left side) after self-retaining retractor placement.
Figure 4.
Figure 4.
Surgical view (left side) after level IIa dissection (ECA: external carotid artery; SAN: spinal accessory nerve; SCM: sternocleidomastoid muscle).
Figure 5.
Figure 5.
Surgical view (right side): the digastric muscle is retracted upwards by the third assistant using an Army-Navy retractor and the spinal accessory nerve (SAN) is dissected.
Figure 6.
Figure 6.
Surgical view (right side): for the dissection of level III, the operation always proceeds in a medial → lateral direction, from the deep plane and the medial-lateral shifting to allow the SAN and the cervical plexus to be identified. (IJV: internal jugular vein; SAN: spinal accessory nerve).
Figure 7.
Figure 7.
Surgical view (right side): dissection of level IV (the omohyoid muscle is retracted) (IJV: internal jugular vein).
Figure 8.
Figure 8.
Modified retroauricular or facelift skin incision and cervical median skin window.
Figure 9.
Figure 9.
Surgical view of submandibular gland removal (right side): considering the working distance and the presence of blood vessels on the muscular surfaces, it can be very useful to carry out this dissection using a 24 cm LigaSure Maryland forceps, in haemostatic mode.

References

    1. Weinstein GS, O’Malley BW, Jr, Snyder W, et al. Transoral robotic surgery: radical tonsillectomy. Arch Otolaryngol Head Neck Surg 2007;133:1220-6. https://doi.org/10.1001/archotol.133.12.1220 10.1001/archotol.133.12.1220 - DOI - PubMed
    1. Weinstein GS, O’Malley BW, Jr, Snyder W, et al. Transoral robotic surgery: supraglottic partial laryngectomy. Ann Otol Rhinol Laryngol 2007;116:19-23. https://doi.org/10.1177/000348940711600104 10.1177/000348940711600104 - DOI - PubMed
    1. Kim WS, Lee HS, Kang SM, et al. Feasibility of robot-assisted neck dissections via a transaxillary and retroauricular (“TARA”) approach in head and neck cancer: preliminary results. Ann Surg Oncol 2012;19:1009-17. https://doi.org/10.1245/s10434-011-2116-2 10.1245/s10434-011-2116-2 - DOI - PubMed
    1. Kim WS, Byeon HK, Park YM, et al. Therapeutic robot-assisted neck dissection via a retroauricular or modified facelift approach in head and neck cancer: a comparative study with conventional transcervical neck dissection. Head Neck 2015;37:249-54. https://doi.org/10.1002/hed.23595 10.1002/hed.23595 - DOI - PubMed
    1. Lee HS, Kim WS, Hong HJ, et al. Robot-assisted supraomohyoid neck dissection via a modified face-lift or retroauricular approach in early-stage cN0 squamous cell carcinoma of the oral cavity: a comparative study with conventional technique. Ann Surg Oncol 2012;19:3871-8. https://doi.org/10.1245/s10434-012-2423-2 10.1245/s10434-012-2423-2 - DOI - PubMed