{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T04:46:58Z","timestamp":1785732418369,"version":"3.56.0"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T00:00:00Z","timestamp":1785715200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Conventional open lateral neck dissection in head and neck cancer is associated with visible cervical scarring and procedure-related morbidity. Although robotic remote-access approaches improve cosmesis, many require larger incisions or provide limited access to certain cervical nodal levels. The Robotic Infraclavicular Approach for Minimally Invasive Neck Dissection (RIA-MIND) was developed to enable comprehensive cervical lymphadenectomy through smaller, cosmetically concealed infraclavicular incisions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a retrospective cohort study of 62 patients who underwent robotic neck dissection using the RIA-MIND technique between July 2018 and May 2025 at a tertiary oncology center. Clinicopathological, perioperative, and oncological data were analyzed, including nodal yield, preservation of key cervical structures, postoperative complications, adjuvant treatment, and recurrence. Learning curve assessment was performed using cumulative sum (CUSUM) analysis of operative (console) time, ipsilateral nodal yield, and perioperative complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The tongue was the most common primary tumor site (67.7%), and squamous cell carcinoma constituted 98.4% of cases. Median ipsilateral and contralateral nodal yields were 25 (IQR 20\u201335) and 17 (IQR 12.25\u201321.25), respectively. The spinal accessory nerve and internal jugular vein were preserved in 98.4% of patients, while the sternocleidomastoid muscle was preserved in 53.2%. Postoperative complications were infrequent, with 87.1% of patients experiencing no documented complications. Recurrence was observed in 5 patients (8.1%), all of which were local recurrences; no regional neck recurrence was observed. CUSUM analysis demonstrated a structured learning curve with progressive improvement in console efficiency, stabilization of ipsilateral nodal yield, and maintenance of perioperative safety over time.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>RIA-MIND is a feasible and safe remote-access robotic technique for unilateral and bilateral neck dissection in selected head and neck cancers, providing satisfactory nodal yield with low perioperative morbidity and favorable early oncologic outcomes. The structured learning curve supports its technical reproducibility; however, further prospective comparative studies with longer follow-up are required to establish long-term oncologic, functional, and cosmetic outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1806241","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T04:28:09Z","timestamp":1785731289000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Robotic infraclavicular approach for minimally invasive neck dissection: an evaluation of safety, oncologic efficacy, and learning curve dynamics in head and neck cancer surgery"],"prefix":"10.3389","volume":"16","author":[{"given":"Athira","family":"Ramakrishnan","sequence":"first","affiliation":[{"name":"Department of Surgical Oncology, MACS-Renova Oncology Institute, KIMS Hospitals (Krishna Institute of Medical Sciences)","place":["Bengaluru, Karnataka, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandeep P.","family":"Nayak","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, MACS-Renova Oncology Institute, KIMS Hospitals (Krishna Institute of Medical Sciences)","place":["Bengaluru, Karnataka, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ameenuddin","family":"Khan","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, MACS-Renova Oncology Institute, KIMS Hospitals (Krishna Institute of Medical Sciences)","place":["Bengaluru, Karnataka, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abhilasha","family":"Sadhoo","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, MACS-Renova Oncology Institute, KIMS Hospitals (Krishna Institute of Medical Sciences)","place":["Bengaluru, Karnataka, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bharath","family":"Gangadhara","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, MACS-Renova Oncology Institute, KIMS Hospitals (Krishna Institute of Medical Sciences)","place":["Bengaluru, Karnataka, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sreekanth","family":"Reddy","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, MACS-Renova Oncology Institute, KIMS Hospitals (Krishna Institute of Medical Sciences)","place":["Bengaluru, Karnataka, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Devaprasad","family":"Munisiddaiah","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, MACS-Renova Oncology Institute, KIMS Hospitals (Krishna Institute of Medical Sciences)","place":["Bengaluru, Karnataka, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suraga","family":"Belakawadi","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, MACS-Renova Oncology Institute, KIMS Hospitals (Krishna Institute of Medical Sciences)","place":["Bengaluru, Karnataka, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"Vinodhini","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, Adyar Cancer Institute","place":["Chennai, Tamil Nadu, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vidyashri","family":"Biral","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, MACS-Renova Oncology Institute, KIMS Hospitals (Krishna Institute of Medical Sciences)","place":["Bengaluru, Karnataka, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keerthi","family":"Ranganathan","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, MACS-Renova Oncology Institute, KIMS Hospitals (Krishna Institute of Medical Sciences)","place":["Bengaluru, Karnataka, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,3]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0326177","article-title":"Space-time analysis of head and neck cancer in Asia and its 34 countries and territories (1990\u20132021): Implications from the Global Burden of Disease Study 2021","volume":"20","author":"Ding","year":"2025","journal-title":"PLoS One"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1222","DOI":"10.18203\/issn.2454-5929.ijohns20193859","article-title":"An approach towards metastatic neck nodes and most common site of primaries: a retrospective study","volume":"5","author":"Prakash","year":"2019","journal-title":"Int J Otorhinolaryngology Head Neck Surg"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.3390\/cancers16172954","article-title":"FDG PET-CT for the detection of occult nodal metastases in head and neck cancer: A systematic review and meta-analysis","volume":"16","author":"Guedj","year":"2024","journal-title":"Cancers"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2022.985761","article-title":"A novel hybrid approach for \u201cscarless\u201d (at the neck) lateral neck dissection for papillary thyroid carcinoma: A case series and literature review","volume":"12","author":"Chen","year":"2022","journal-title":"Front Oncol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1007\/s13193-015-0474-0","article-title":"Minimally invasive neck dissection (MIND) using standard laparoscopic equipment: a preliminary report and description of technique","volume":"8","author":"Nayak","year":"2015","journal-title":"Indian J Surg Oncol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.4103\/jmas.jmas_40_18","article-title":"Minimally invasive neck dissection: A 3-year retrospective experience of 45 cases","volume":"15","author":"Nayak","year":"2018","journal-title":"J Minimal Access Surg"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1007\/s12070-020-02066-7","article-title":"Efficacy and safety of novel minimally invasive neck dissection techniques in oral\/head and neck cancer: A systematic review and meta-analysis","volume":"74","author":"Nayak","year":"2020","journal-title":"Indian J Otolaryngol Head Neck Surg"},{"key":"B8","doi-asserted-by":"publisher","first-page":"395","DOI":"10.4103\/jmas.jmas_223_22","article-title":"Robotic infraclavicular approach for minimally invasive neck dissection in head-neck cancers","volume":"19","author":"Khan","year":"2023","journal-title":"J Minimal Access Surg"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-011-2116-2","article-title":"Feasibility of robot-assisted neck dissections via a transaxillary and retroauricular (\u201cTARA\u201d) approach in head and neck cancer: preliminary results","volume":"19","author":"Kim","year":"2011","journal-title":"Ann Surg Oncol"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.21037\/gs.2017.09.09","article-title":"Gasless, transaxillary robotic neck dissection: the technique and evidence","volume":"7","author":"Kang","year":"2018","journal-title":"Gland Surg"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.3978\/j.issn.2227-684X.2015.02.07","article-title":"Robotic facelift thyroid surgery","volume":"4","author":"Bomeli","year":"2015","journal-title":"Gland Surg"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.21037\/gs-2024-535","article-title":"Feasibility and outcomes of remote-access endoscopic and robotic lateral neck dissection for thyroid cancer: a scoping review","volume":"14","author":"Wang","year":"2025","journal-title":"Gland Surg"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.3390\/curroncol29090527","article-title":"Dealing with the vicissitudes and abject consequences of head and neck cancer: A vital role for psycho-oncology","volume":"29","author":"Mascarella","year":"2022","journal-title":"Curr Oncol"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1155\/2017\/8362874","article-title":"Management of chyle leak after head and neck surgery: Review of current treatment strategies","volume":"2017","author":"Delaney","year":"2017","journal-title":"Int J Otolaryngol"},{"key":"B15","doi-asserted-by":"publisher","first-page":"87","DOI":"10.36106\/gjra\/1905482","article-title":"Thoracic duct injury in neck dissection surgery: Analysing frequency and its management techniques","volume":"14","author":"Rawal","year":"2025","journal-title":"Global J For Res Anal"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.3760\/cma.j.cn115330-20211231-00837","article-title":"Preliminary experience of robotic lateral neck dissection via combined axillary-retroauricular approach for N1b papillary thyroid carcinoma","volume":"57","author":"Liang","year":"2022","journal-title":"Chin J Otorhinolaryngology Head Neck Surg"},{"key":"B17","doi-asserted-by":"publisher","first-page":"664","DOI":"10.18203\/2349-2902.isj20190811","article-title":"Management of neck dissection complications in head and neck cancers","volume":"6","author":"Bhushan","year":"2019","journal-title":"Int Surg J"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.25834","article-title":"Nodal yield and survival in oral squamous cancer","volume":"117","author":"Ebrahimi","year":"2011","journal-title":"Cancer"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1007\/s13193-021-01444-z","article-title":"Feasibility, safety, nodal yields and learning curves in retroauricular robot\/endoscope assisted neck dissection in the management of head and neck cancer","volume":"12","author":"Kathar","year":"2021","journal-title":"Indian J Surg Oncol"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1007\/s12663-019-01261-6","article-title":"Efficacy of single transverse neck incision for modified radical neck dissection","volume":"19","author":"Mandlik","year":"2019","journal-title":"J Maxillofac Oral Surg"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1002\/rcs.70112","article-title":"Quality of lymph node dissection in lung cancer surgery: A comparative analysis of robotic\u2010assisted versus video\u2010assisted thoracic surgery using novel pathological criteria","volume":"21","author":"Deceuninck","year":"2025","journal-title":"Int J Med Rob Comput Assisted Surg"},{"key":"B22","doi-asserted-by":"publisher","first-page":"1191","DOI":"10.1001\/jamaoto.2014.2830","article-title":"Learning curve for robot-assisted neck dissection in head and neck cancer","volume":"140","author":"Kim","year":"2014","journal-title":"JAMA Otolaryngology\u2013Head Neck Surg"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2013.3007","article-title":"Learning curve for transoral robotic surgery: a 4-year analysis","volume":"139","author":"White","year":"2013","journal-title":"JAMA Otolaryngol Head Neck Surg"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2017.02.022","article-title":"Complications following transoral robotic surgery (TORS): A detailed institutional review of complications","volume":"67","author":"Hay","year":"2017","journal-title":"Oral Oncol"},{"key":"B25","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1007\/s11934-017-0738-z","article-title":"Learning curves for robotic surgery: a review of the recent literature","volume":"18","author":"Mazzon","year":"2017","journal-title":"Curr Urol Rep"},{"key":"B26","doi-asserted-by":"publisher","first-page":"542","DOI":"10.1001\/jamaoto.2016.4132","article-title":"Assessment of surgical learning curves in transoral robotic surgery for squamous cell carcinoma of the oropharynx","volume":"143","author":"Albergotti","year":"2017","journal-title":"JAMA Otolaryngology\u2013Head Neck Surg"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1806241\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T04:28:11Z","timestamp":1785731291000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1806241\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,3]]},"references-count":26,"alternative-id":["10.3389\/fonc.2026.1806241"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2026.1806241","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,3]]},"article-number":"1806241"}}