Bilateral infraclavicular-approach for prophylactic robotic neck dissection (BIRD): Preliminary results

Robotic neck dissection has emerged as a minimally invasive alternative to conventional open surgery, providing enhanced surgical precision, reduced morbidity, and improved cosmetic outcomes. Advances in technology and refinement of surgical techniques have broadened the applicability of robotic approaches in head and neck oncology. This study aims to describe a novel robotic approach for neck dissection and assess its technical feasibility, safety, and short-term perioperative outcomes.

Patients with early-stage oral cavity squamous cell carcinoma who did not require neck access for flap reconstruction were selected for the procedure. A bilateral infraclavicular approach for robotic neck dissection (BIRD) was performed with the Intuitive da Vinci Xi Surgical System. Outcomes assessed included lymph node yield, as well as intraoperative and postoperative complications.

Three patients underwent the BIRD procedure. All underwent selective neck dissection (levels I-IV) without a visible cervical scar. Lymph node yield ranged from 24 to 39, with a mean of 30. Intraoperative blood loss ranged from 150 to 225 ml (mean 183 ml). No major intraoperative complications, including vascular injury, chyle leak, conversion to open surgery, or re-exploration, were observed. Drain output was <25 ml per 24 hours by postoperative day 4 in all patients. Postoperative assessment revealed normal function of the spinal accessory, hypoglossal, and marginal mandibular nerves in all cases.

BIRD is a technically feasible approach for prophylactic neck dissection in early-stage oral cavity squamous cell carcinoma. It respects established oncologic principles in terms of lymph node yield, and is associated with acceptable short-term functional and cosmetic outcomes.