In the last one decade, head and neck oncological surgery have shown remarkable progress with the development of several modalities of endoscopic-assisted minimally invasive surgeries. More recently, the da Vinci robotic surgery system has popularised the development of several surgical approaches with less morbidity and better cosmetic results, including transoral robotic surgery(TORS), the transaxillary and retroauricular approaches for thyroid surgery and neck dissections. This is new technology and recent surgical innovation. This is a remote access surgery for good cosmesis to improve quality of life. Robot assisted surgery enhances visualization, allows for high level of precision and can reduce the risk of injuries of nerve, especially for thyroid nodule in young females, robot assisted thyroidectomy can be done without any visible scar in the neck.

Head and neck surgery is characterized by the manipulation of a highly complex layered anatomy with multiple important (some vital) and delicate structures confined in tight spaces. The traditional surgical approach uses large incisions in visible areas of the human body, frequently resulting in significant aesthetical and functional morbidity. Scar becomes hallmark of head neck oncosurgery. There has been an increasing concern to reduce morbidity (without jeopardizing oncological safety) and to improve quality of life and patient satisfaction. 

The robot offers the surgeon a three-dimensional view and a magnification of the operative field, with several angles of vision. The visualization of depth and the clear discernment of planes and tissues allow small anatomical structures to be distinguished and consequently it reduces the risk of damage. These procedures have resulted in a significant increase in cosmesis and quality of life of the selected treated patients.

The most important surgical instrument that facilitate such approaches is megaretractor, a special type of retractors used in robotic and endoscopic thyroidectomy, neck dissection and other neck surgeries for malignant conditions of the head and neck. This is used in retroauricular as well as transaxillary approaches. Retroauricular and transaxillary approaches are newer approaches in which neck incisions can be avoided so that post radiotherapy patient will have less skin swelling, apart from hiding the scars which is hallmark of head and neck cancer surgeries. We give incision in retroauricular area behind the ear and in the hairline so that scar will be well hidden and patient will have no visible scar in the neck
 

 

Robotic head and neck surgery includes various surgical procedures:

Transoral robotic surgery (TORS) for oropharyngeal, laryngeal, hypopharyngeal and parapharyngeal tumor, 

Robot assisted hemithyroidectomy , total thyroidectomy with central and lateral neck dissection for thyroid tumor,

Scarless neck robot assisted parathyroidectomy,

Robot assisted retroauricular neck dissection for oral cavity and oropharyngeal cancer,

Scarless neck robot assisted submandibular gland excision