Retroauricular Robotic Neck Dissection

  • Renan Bezerra Lira
  • Luiz Paulo Kowalski

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Neck dissections have been performed for more than a century and is considered an essential part of the treatment of most head and neck cancer patients. However, the traditional technique is associated with significant functional impairments. In the last 30 years, several modifications have been established aiming to reduce morbidity. However, it is still performed through large incisions in visible areas of the neck. The aesthetic results are not satisfactory, especially for young patients with oropharynx and thyroid cancer.

Head and neck oncologic surgery has progressed remarkably with the development of minimally invasive surgical procedures. These procedures have led to significant improvements in satisfaction and quality of life of treated patients, targeting functional and aesthetic objectives without compromising oncological results. Among these advances, endoscopic and robotic procedures have been incorporated by many centers around the world. In addition to the well-established use of transoral robotic surgery for oropharyngeal and laryngeal carcinomas, the use of the DaVinci robotic system has promoted the development of several remote surgical approaches to the neck, including the retroauricular/facelift approach for thyroidectomy, neck dissection and salivary gland resection.

This alternative access was described by Korean authors (Koh and Choi) and its application initially grew in Asia, especially in South Korea. However, in the last years, other centers from around the globe, including Brazil, India, Germany and USA, have been performing robotic neck dissection and exploring its safety, feasibility and outcomes. In selected cases, these surgical techniques eliminate the need for large visible neck incisions and provide superior functional and aesthetic results, having an acceptable cost and generating similar complication rates and oncologic outcomes, when compared to traditional procedures.

The authors introduced the method in South America, and have reported the initial results in the medical literature.


This video will focus on the techniques and early outcomes (functional and oncologic) of robotic neck dissection.

About The Author

Renan Bezerra Lira

Renan B. Lira is a head and neck / robotic surgeon. Since 2014, he has been a leader in robotic and endoscopic thyroid and head and neck surgery, and has pioneered several of these techniques in Latin America. His group has extensive experience in robotic neck surgery, which is unequaled in Latin America (and probably outside Asia), and has published 5 papers in the field.

He obtained his medical degree at the School of Medicine, Federal University of Rio Grande do Norte State, RN, Brazil (2001-2007). He completed his residency in General Surgery at Irmandade da Santa Casa de Misericórdia de São Paulo (ISCMSP) (2008-2010) and in Head and Neck Surgery at the AC Camargo Cancer Center, São Paulo (2011-2013). He received his PhD in Oncology from the School of Medicine, University of São Paulo (2014-2017).

He is now an Attending Surgeon at the Department of Head and Neck Surgery and Vice Coordinator of the Robotic Surgery Program at the AC Camargo Cancer Center, São Paulo, Brazil.

Luiz Paulo Kowalski

Luiz Paulo Kowalski MD, PhD is a head and neck / robotic surgeon. Since 2014, he has been a leader in robotic and endoscopic head and neck surgery, and he is the chairman of a pioneering group of surgeons in several of these techniques in Latin America.

He completed his residency in Surgical Oncology at the AC Camargo Cancer Center, São Paulo (1980-1983), fellowship in Head and Neck Surgery at Hospital Heliopolis, São Paulo, (1983-1984) and an observership in Head and Neck Surgery Service at Memorial Sloan Kettering Cancer Center (MSKCC), where he first came into contact with one of his most important mentors, Jatin P. Shah.

He received his MS (1986) and PhD (1989) degrees in Otorhinolaryngology from the Federal University of São Paulo.

Since 1990, he has been the Director of the Head and Neck Surgery and Otorhinolaryngology Department at the AC Camargo Cancer Center. He is also a Professor at the AC Camargo Cancer Center (since 1991) and a Full Professor of Oncology at the University of São Paulo, (1996).

He has published 541 articles (418 referenced on PubMed), edited 11 books, authored or co-authored 135 book chapters and is a member of 15 Editorial Boards (including Head and Neck and Oral Oncology).

He was President of the Brazilian Head and Neck Cancer Society (2005-2007), President of the International Academy of Oral Oncology (IAOO) (2015-2017) and is currently the Vice-President of the International Guild of Robotic and Endoscopic Head & Neck Surgery (IGReHNS).


About this video

Renan Bezerra Lira
Luiz Paulo Kowalski
Online ISBN
Total duration
20 min
Springer, Cham
Copyright information
© The Author(s) 2019

Video Transcript

This video is a demonstration of robotic neck dissection using retroauricular approach. I am Dr. Renan Lira, a head and neck surgeon from A.C. Camargo Cancer Center in Sao Paulo, Brazil.

Neck dissections are standard procedures in the treatment of head and neck cancer, but usually associated with large unaesthetic neck scars. However, in the last years, the evolution of video- and robotic-assisted surgery led to the development of remote approaches to the neck with better aesthetic outcomes, such as retroauricular approach.

This approach allows ipsilateral comprehensive and selective neck dissection, including all levels, levels I, II, III, IV, V, VI, and VII. In this video, you’ll see a demonstration of a left retroauricular lower robotic selective neck dissection of levels I, II, and III in a patient with a T2 oral carcinoma.

All patients must be submitted to proper pre-operative assessment, including imaging and staging of the neck. Also, primary tumor resection must be considered, as well as the possibilities of reconstruction.

Robotic neck dissection of levels I, II and III, or I, II, III, and IV are indicated in patients with N0 or N1 oral or oropharyngeal carcinomas, salivary gland carcinomas, and patients motivated to avoid a visible neck scar. Previous neck radiation is not an absolute contraindication for this procedure.