Transoral robotic retropharyngeal lymph node dissection in a recurrent head and neck carcinoma.

BACKGROUND: A step-by-step demonstration of the transoral robotic surgical approach (TORS) used in retropharyngeal node dissection (RND) in a recurrent head and neck carcinoma. METHODS: Clinical human study of TORS RND via en bloc resection using a daVinci Si system (Intuitive Surgical, Inc., Sunnyvale, California). RESULTS: A daVinci Si system provided sufficient access, reach, and visualization to perform TORS-RND. Access and exposure were achieved with a Feyh-Kastenbauer (FK) retractor (Gyrus Medical Inc., Tuttlingen, Germany). Two surgical instruments and one 3D camera arm can be deployed with minimal collision or restriction of arm movement. CONCLUSIONS: Routine transcervical, transparotid, and transmandibular RNDs can provoke potentially serious surgical morbidities and complications. This study demonstrates the technical feasibility of TORS RND in a 68-year-old man.