title: Gasless transaxillary robot-assisted neck dissection: a preclinical feasibility study in four cadavers.
abstract: OBJECTIVE
  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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Otolaryngology, School of Medicine, Ajou University, Suwon, Korea.
authors.forename: Yoo Seob
authors.initials: YS
authors.lastname: Shin
authors.forename: Hyun Jun
authors.initials: HJ
authors.lastname: Hong
authors.forename: Yoon Woo
authors.initials: YW
authors.lastname: Koh
authors.forename: Woong Youn
authors.initials: WY
authors.lastname: Chung
authors.forename: Hye Yeon
authors.initials: HY
authors.lastname: Lee
authors.forename: Jae Min
authors.initials: JM
authors.lastname: Hong
authors.forename: Chi Sang
authors.initials: CS
authors.lastname: Hwang
authors.forename: Jae Won
authors.initials: JW
authors.lastname: Chang
authors.forename: Eun Chang
authors.initials: EC
authors.lastname: Choi
mesh_terms: D002102:Cadaver; D004724:Endoscopy / Q000295:instrumentation / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D009333:Neck / Q000098:blood supply / Q000294:innervation / Q000601:surgery; D037981:Neck Dissection / Q000295:instrumentation* / Q000379:methods*; D018307:Neoplasms, Squamous Cell / Q000601:surgery*; D012371:Robotics / Q000379:methods*; D013964:Thyroid Neoplasms / Q000601:surgery*