The introduction of MiRA (Micro Robotic Access) for subclavicular neck dissection

Robotic-assisted surgery has progressively expanded in head and neck diseases, providing minimally invasive alternatives to conventional transcervical approaches while improving visualization, precision, ergonomics, and cosmetic outcomes. The MiRA (Micro Robotic Access) pneumoneck technique was developed as a fully robotic subclavicular approach for lateral neck dissection. The technique combines small subclavicular ports, carbon dioxide insufflation to create a stable cervical working space, and the Asson assistant port system to optimize pressure stability and auxiliary instrument use. The MiRA pneumoneck technique was applied in a female patient with squamous cell carcinoma of the oral floor who underwent a right selective lateral neck dissection. Four subclavicular incisions were created for robotic and assistant ports. Pneumoneck was established using CO₂ insufflation, and the procedure was performed with the Da Vinci Xi Surgical System. Robotic dissection enabled en-bloc clearance of cervical levels I-III while preserving major neurovascular structures. The specimen was removed through the assistant port. Postoperative recovery was uneventful, with no major complications, early mobilization, and discharge on postoperative day 4. Compared with previously described robotic neck approaches, the MiRA pneumoneck technique represents a fully remote-access strategy for lateral neck surgery without visible cervical incisions. CO₂ insufflation improves visualization and instrument maneuverability, while the Asson system reduces gas leakage and enhances procedural versatility. The MiRA pneumoneck technique represents a further evolution in minimally invasive robotic neck surgery. Further studies are required to evaluate reproducibility, oncologic safety, cost-effectiveness, and long-term outcomes.