A new endoscopic surgical approach to the larynx, hypopharynx, and neck lymphatics: The robotic-assisted extended "Sistrunk" approach (RESA).

Abstract

We report on the feasibility of a novel robotic-assisted extended "Sistrunk" approach (RESA) to the larynx, hypopharynx, and lateral neck lymphatics. Studies were performed using the da Vinci Xi and SP system on three cadavers comprising of three supraglottic laryngectomies, one partial hypopharyngectomy, and four lateral level II to IV neck dissections. In all resections at first a central common working space overlying the hyoid bone was created. The da Vinci Xi system was used with two vestibular and two submental ports for laryngeal/hypopharyngeal resections, and an additional port through a facelift incision for level II to IV neck dissections. The da Vinci SP system was used with only one submental port. We describe herein a novel endoscopic robotic approach to the larynx, hypopharynx, and neck based on the traditional "Sistrunk" procedure. The technique should help improving exposure of the primary lesion and reduce access-related morbidity to the neck.