Robotic infraclavicular approach for minimally invasive neck dissection: an evaluation of safety, oncologic efficacy, and learning curve dynamics in head and neck cancer surgery.

Introduction: 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. Methods: 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. Results: 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 20-35) and 17 (IQR 12.25-21.25), 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. Conclusion: 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.