Advanced Developments in Neck Dissection Technique: Perspectives in Minimally Invasive Surgery

Over the last decade, surgeons have experienced dramatic changes in operative procedures as a result of the development of remarkable new technological tools that have enabled significant advances in minimally invasive surgical techniques and instruments. These advances have led to the increased application of minimally invasive techniques for “nonconventional” procedures. The potential benefits of minimally invasive surgery have included reduced levels of trauma to the tissues, decreased postoperative pain, reduced length of hospital stay, and better cosmetic outcomes. Various types of minimally invasive operative techniques have been introduced, including mini-incision, video-assisted, endoscopic, robotic, laparoendoscopic single-site surgery (LESS), and natural orifice transluminal endoscopic surgery (NOTESTM). In head and neck surgery, where vital structures are in close proximity to each other, and the operative field is a deep and narrow space, these minimally invasive approaches can be especially challenging. Minimally invasive surgery is not minimum surgery, and the principle of complete tumor resection must still be followed. Therefore, head and neck surgeons have often avoided minimally invasive techniques due to concerns about visualization, damage to vital structures, and limited availability of instruments specific to the delicate tasks required of the head and neck surgeon. Minimally invasive neck surgery through totally endoscopic or video-assisted techniques, which are currently being used around the globe for thyroid and parathyroid surgeries, enables a smaller wound size or allows for the positioning of the wound in areas of cosmetic benefit. Since Michel Gagner first described endoscopic neck surgery in 1996, endoscopic procedures based on various approaches have been widely applied. In addition to minimized scarring and improved cosmetic results, the adoption of endoscopic procedures has offered several extra advantages, such as diminished postoperative hyperesthesia or paresthesia of the anterior neck and less patient discomfort during swallowing, which may sometimes result from the conventional transverse cervical incision. However even with these potential advantages, the technical limitations of endoscopic neck surgery, which are shared by many other types of minimally invasive surgery, have remained a significant consideration. The skills required in using straight, rigid endoscopic instruments without articulations and a two-dimensional (2D) view are radically different from those applied in