Robot-Assisted Neck Lymphadenectomy Through a Retroauricular–Posterior Cervical Approach

Objective. To evaluate the functional and aesthetic outcomes of robot-assisted neck lymphadenectomy performed via a postauricular–posterior cervical approach compared with open neck lymphadenectomy via an anterolateral approach in patients with head and neck malignancies.
Material and methods. A prospective, single-center comparative study was conducted between January 2022 and December 2024 and included 58 patients with histologically confirmed head and neck malignancies. Patients were allocated into two equal groups: conventional open neck lymphadenectomy (n=29) and robot-assisted neck lymphadenectomy performed via a postauricular–posterior cervical approach (n=29). Functional outcomes were assessed based on the incidence, severity, and duration of motor and sensory deficits associated with intraoperative manipulation of peripheral nerves in the lateral neck. Aesthetic outcomes were evaluated according to the visibility of the postoperative scar and patient-reported satisfaction using a visual analog scale (VAS 0–10 points).
Results. The incidence of neurological complications was significantly lower in the robot-assisted group compared with the conventional anterolateral approach (4.8% vs. 17.2%; p<0.05). All functional deficits were transient; the mean time to functional recovery was 2.5 ± 0.8 months after robot-assisted lymphadenectomy and 3.8±1.2 months after the conventional approach (p<0.05). Aesthetic outcomes were significantly superior in the robot-assisted group: mean patient satisfaction score was 9.3±0.7 compared with 6.8±1.1 in the conventional group (p<0.001), and an aesthetically favorable outcome was observed in 87% and 62% of patients, respectively (p<0.05).
Conclusion. Robot-assisted neck lymphadenectomy performed via a postauricular–posterior cervical approach provides significantly better functional and aesthetic outcomes compared with conventional open neck lymphadenectomy via an anterolateral approach in patients with head and neck malignancies. The technique is associated with a lower incidence of neurological complications, shorter functional recovery time, and higher patient satisfaction with aesthetic results, supporting its safety and clinical feasibility in a carefully selected patient population.
Keywords: robot-assisted surgery, neck lymphadenectomy, retroauricular-posterior cervical approach, head and neck oncology, minimally invasive surgery, cervical lymph nodes, da Vinci Si system
Conflict of interest. The authors declare no conflict of interest.
Funding. The study was performed without external funding.