Robot-Assisted Gasless Trans-Hairline Excision of Submandibular Gland Tumors.

Abstract

Benign submandibular gland tumors are usually resected through a transcervical incision, which provides direct exposure but leaves visible cervical scarring. Remote-access endoscopic techniques improve scar concealment but can be limited by two-dimensional visualization, assistant-dependent camera control, and rigid instrument collision in the narrow submandibular gland space. This article presents a standardized video protocol for robot-assisted submandibular gland excision via a gasless trans-hairline approach for benign tumors. The procedure begins with postauricular trans-hairline incision design, subplatysmal flap elevation, and mechanical retractor-based creation of a gasless working cavity. After robotic docking, a 3D endoscope and articulated instruments are used for sequential dissection of the superior, posterior, inferior, deep, and anterior glandular borders. Critical steps include protection of the marginal mandibular branch of the facial nerve, management of the facial vein and facial artery branches, exposure of the digastric and mylohyoid muscles, identification of the lingual nerve, division of submandibular ganglion branches, clipping of Wharton's duct, en bloc gland-and-tumor retrieval, hemostasis, drainage, and layered closure. Ten female patients with clinically benign submandibular gland tumors underwent this procedure. All operations were completed robotically without conversion. The mean operative time was 134.5 min ± 36.9 min, the mean estimated blood loss was 16.2 mL ± 7.6 mL, and the mean incision length was 5.6 ± 0.5 cm. Final pathology confirmed pleomorphic adenoma in all patients. No major vascular injury, postoperative marginal mandibular, lingual, or hypoglossal nerve dysfunction, hematoma, seroma, infection, or salivary fistula was observed during the available follow-up. This protocol provides a reproducible workflow for selected patients, although larger studies with longer follow-up are needed.