Robotic Surgery in Head and Neck in Pediatric Population: Our Experience

  • C. Venkatakarthikeyan
  • Swati NairEmail author
  • M. Gowrishankar
  • Soorya Rao
Original Article


Robot assisted surgery of the head and neck is a relatively novel approach in the management of head and neck tumors. There are very few reported cases of robot-assisted surgery of the head and neck in pediatric population in the world literature and no report of such procedures in the Indian subcontinent. In this article we present three such cases we performed for the first time in the country. The first case is that of second branchial cleft cyst, the second is a 4-year-old boy with a tongue base cyst and the third patient is a 12-year-old girl with left parotid gland tumor. All the patients underwent successful Robotic surgeries. Case 1 underwent robotic excision of the cyst through a retroauricular hairline incision. Case 2 underwent transoral robotic excision of the tongue base cyst. Case 3 underwent robotic excision of the tumor through a modified facelift incision. The mean docking time for the robot was 12.33 min and approximate blood loss was less than 10 ml in all cases. The patient and their parents were extremely satisfied with the cosmetic outcomes of the scarless surgery. Robot assisted surgery has the advantage of performing minimally invasive procedures within constrained spaces especially in children. The multiarticulated endowrist movements of the robotic arms combined with higher magnification and three-dimensional depth perception allows a precise surgery with better visualization in otherwise inaccessible areas resulting in better surgical outcome. With exceptional advantages of scarless surgery, minimal blood loss and postoperative pain and better surgeon ergonomics, robotic technique is an effective and feasible option in Pediatric Head and neck Surgery.


Da Vinci Retroauricular approach Transoral robotic surgery (TORS) Branchial cleft cyst Epidermoid cyst Pediatric 


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee.

Informed Consent

Informed consent was obtained from all participants included in the study.


  1. 1.
    Koeller KK, Alamo L, Adair CF, Smirniotopoulos JG (1999) Congenital cystic masses of the neck: radiologic-pathologic correlation. Radiographics 19(1):121–146CrossRefGoogle Scholar
  2. 2.
    Pancholi A, Raniga S, Vohra P, Vaidya V (2005) Midline submental epidermoid cyst: a rare case. Internet J Otorhinolaryngol 4(2):1–5Google Scholar
  3. 3.
    Meyer I (1955) Dermoid cyst of the floor of the mouth. Oral Surg Oral Med Oral Pathol 8:1149–1164CrossRefGoogle Scholar
  4. 4.
    Smirniotopoulos JG, Chiechi MV (1995) Teratomas, dermoids, and epidermoids of the head and neck. Radiographics 15(6):1437–1455CrossRefGoogle Scholar
  5. 5.
    Longo F, Maremonti P, Mangone GM, De Maria G, Califano L (2003) Midline (dermoid) cysts of the floor of the mouth: report of 16 cases and review of surgical techniques. Plast Reconstr Surg 112(6):1560–1565CrossRefGoogle Scholar
  6. 6.
    Koca H, Seckin T, Sipahi A, Kazanc A (2007) Epidermoid cyst in the floor of the mouth: report of a case. Quintessence Int 38(6):473–477PubMedGoogle Scholar
  7. 7.
    Seah TE, Sufyan W, Singh B (2004) Case report of a dermoid cyst at the floor of the mouth. Ann Acad Med Singapore 33(4):77–79PubMedGoogle Scholar
  8. 8.
    Bateman N, Lawrence R (2018) Chapter 39, salivary glands. In: Watkinson JC, Clarke RW (eds) Scott-Brown’s otorhinolaryngology head and neck surgery, 8th edn, vol 2. Taylor & Francis Group, LLC, London, p. 447Google Scholar
  9. 9.
    Zielinski R, Kobos J, Zakrzewska A (2014) Parotid gland tumors in children: pre- and post-operative diagnostic difficulties. Pol J Pathol 65(2):130–134CrossRefGoogle Scholar
  10. 10.
    Bradley PJ, Eisele DW (2016) Salivary gland neoplasms in children and adolescents. Adv Otorhinolaryngol 78:175–181PubMedGoogle Scholar
  11. 11.
    Lennon P, Cunningham MJ (2015) Salivary gland tumors. In: Rahbar R (ed) Pediatric head and neck tumors: A–Z guide to presentation and multimodality management. Springer, Boston, pp 311–327Google Scholar
  12. 12.
    Sato T, Kamata SE, Kawabata K, Nigauri T, Mitani H, Beppu T et al (2005) Acinic cell carcinoma of the parotid gland in a child. Pediatr Surg Int 21(5):377–380CrossRefGoogle Scholar
  13. 13.
    Camacho AE, Goodman ML, Eavey RD (1989) Pathologic correlation of the unknown solid parotid mass in children. Otolaryngol Head Neck Surg 101(5):566–571CrossRefGoogle Scholar
  14. 14.
    Levine SB, Potsic WP (1986) Acinic cell carcinoma of the parotid gland in children. Int J Pediatr Otorhinolaryngol 11(3):281–286CrossRefGoogle Scholar
  15. 15.
    Bailey H (1929) Branchial cysts and other essays on surgical subjects in the fascio-cervical region. H. K. Lewis & Company, LondonGoogle Scholar
  16. 16.
    Dutta S, Slater B, Butler M, Albanese CT (2008) “Stealth Surgery”: transaxillary subcutaneous endoscopic excision of benign neck lesions. J Pediatr Surg 43:2070–2074CrossRefGoogle Scholar
  17. 17.
    Chen LS, Sun W, Wu PN, Zhang SY, Xu MM, Luo XN et al (2012) Endoscope-assisted versus conventional second branchial cleft cyst resection. Surg Endosc 26:1397–1402CrossRefGoogle Scholar
  18. 18.
    Shin YS, Chung HP, Shin HA, Lee HJ, Koh YW, Choi EC (2012) Endoscopic axillo-breast approach for benign neck mass excision. Laryngoscope 122(3):559–564CrossRefGoogle Scholar
  19. 19.
    Roh JL, Yoon YH (2008) Removal of pediatric branchial cleft cyst using a retroauricular hairline incision (RAHI) approach. Int J Pediatr Otorhinolaryngol 72(10):1503–1507CrossRefGoogle Scholar
  20. 20.
    Van Loey NE, Van Son MJ (2003) Psychopathology and psychological problems in patients with burn scars: epidemiology and management. Am J Clin Dermatol 4(4):245–272CrossRefGoogle Scholar
  21. 21.
    Gilboa D, Bisk L, Montag I, Tsur H (1999) Personality traits and psychosocial adjustment of patients with burns. J Burn Care Rehabil 20(4):340–346PubMedGoogle Scholar
  22. 22.
    Rahbar R, Ferrari LR, Borer JG, Peters CA (2007) Robotic surgery in the pediatric airway: application and safety. Arch Otolaryngol Head Neck Surg 133(1):46–50CrossRefGoogle Scholar
  23. 23.
    Thottam PJ, Govil N, Duvvuri U, Mehta D (2015) Transoral robotic surgery for sleep apnea in children: is it effective? Int J Pediatr Otorhinolaryngol 79(12):2234–2237CrossRefGoogle Scholar
  24. 24.
    Leonardis RL, Duvvuri U, Mehta D (2013) Transoral robotic-assisted lingual tonsillectomy in the pediatric population. JAMA Otolaryngol Head Neck Surg 139(10):1032–1036CrossRefGoogle Scholar
  25. 25.
    Kayhan FT, Yigider AP, Koc AK, Kaya KH, Erdim I (2017) Treatment of tongue base masses in children by transoral robotic surgery. Eur Arch Otorhinolarngol 274(9):3457–3463CrossRefGoogle Scholar
  26. 26.
    Zdanski CJ, Austin GK, Walsh JM, Drake AF, Rose AS, Hackman TG, Zanation AM (2017) Transoral robotic surgery for upper airway pathology in the pedatric population. Laryngoscope 127(1):247–251CrossRefGoogle Scholar
  27. 27.
    Roh JL (2005) Retroauricular hairline incision for removal of upper neck masses. Laryngoscope 115:2161–2166CrossRefGoogle Scholar
  28. 28.
    Hockstein NG, Nolan JP, O’Malley BW Jr, Woo YJ (2005) Robotic microlaryngeal surgery: a technical feasibility study using the da Vinci surgical robot and an airway mannequin. Laryngoscope 115(5):780–785CrossRefGoogle Scholar

Copyright information

© Association of Otolaryngologists of India 2019

Authors and Affiliations

  1. 1.Department of Otorhinolaryngology and Head and Neck SurgeryApollo Main HospitalChennaiIndia
  2. 2.Department of Otorhinolaryngology and Head and Neck SurgeryApollo Main HospitalDelhiIndia
  3. 3.Department of Otorhinolaryngology and Head and Neck SurgeryApollo Main HospitalChennaiIndia

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