Dr. Praveen Ravishankaran

• Thoracic Surgery

a). Laparoscopic and Robotic transthoracic esophagectomy

b). VATS lung resections(benign and malignant)

c). VATS mediastinal resections

• Gl surgeries

a) Laparoscopic and Robotic colorectal surgeries

b) Liver and pancreatic surgeries

c) Total and extended total gastrectomies

d) Whipples procedures

• Gynaecological procedures

a) Cytoreductive surgeries and HIPEC surgery

b) PIPAC procedures

c) Pelvic exenterative procedures

d) Robotic and Laproscopic staging procedures

• Bone/Soft Tissue Sarcoma

a) Limb Salvage surgeries with prosthetic reconstruction

b) Internal hemipelvectomies

• Breast Procedures

a) Breast Oncoplasty procedures

b) Sentinel node biopsy procedures'

• Head and Neck Surgeries

a) Composite resections fofr advanced oral cavity carcinoma

b) Robotic Thyroidectomies/ Parotidectomies

c) Larynx preservation surgeries

d) Free flap reconstruction procedures

• 2016-Tamil Nadu Dr.MGR University Gold Medal in M.Ch Surgical Oncology
• 2015-Best outgoing Student Award for M.Ch Surgical Oncology, Cancer Institute (WIA), Adyar, Chennai
• 2016-Tamil Nadu Dr.MGR University Gold Medal in M.Ch Surgical Oncology

• Articles Published in International Indexed Journals

1) Prognostic value of metastatic lymph nodal ratio in carcinoma esophagus- A three step extrapolative

study

2) Exploring the role of DMSA scan in medullary carcinoma thyroid carcinoma patients with postoperative persistent hypercalcaemia in PET scan

3) Clinical significance of preoperative IL-6 and CRP in Breast Cancer patients

4) Correlation of IL-6, CRP and Serum Lactate to inflammation, complication and outcome during the surgical course of patients with acute abdomen

• Case reports published in indexed Journals

1) Ectopic thyroid masquerading as a lateral neck mass

2) Evisceration of appendix through the drain site.

3) Left sided amyands hernia a rare case reported

4) Liver abscess with pyopericardium - Laparoscopic management in preterm neonate

Robotic-Assisted Total Parotidectomy — A New Frontier at GKNM Hospital, Coimbatore

Introduction

Parotidectomy is one of the most delicate procedures in head and neck surgery, primarily because of the close relationship between the parotid gland and the branches of the facial nerve. Traditionally, this operation has been performed through a long pre- and post-auricular incision extending into the neck. The visibility of the nerves are also diminished in open procedure. With the advent of robotic technology, a new era of minimally invasive, cosmetically superior, and functionally precise head and neck surgeries has emerged.

At G. Kuppuswamy Naidu Memorial (GKNM) Hospital, Coimbatore, the first robotic-assisted total parotidectomy was recently performed under the leadership of Dr. Praveen Ravishankaran, Consultant Surgical Oncologist and expert in robotic and minimally invasive oncology. This milestone represents a significant leap in the adoption of advanced surgical techniques for head and neck malignancies and benign lesions, combining oncologic safety with aesthetic excellence.

Case Overview

A middle-aged patient presented with a progressively enlarging, painless swelling in the right parotid region over several months. Clinical examination revealed a well-defined, mobile mass located in the parotid region without any facial weakness or skin involvement. Ultrasonography and contrast-enhanced MRI confirmed a lesion involving the parotid gland, with no invasion into surrounding structures. Fine-needle aspiration cytology (FNAC) suggested a pleomorphic adenoma with atypia.

Given the dual goals of achieving complete resection and maintaining a superior functional outcome, a robotic-assisted total parotidectomy was planned. The Da Vinci Xi robotic system available at GKNM Hospital was employed for this procedure.

Pre-operative Planning and Positioning

After detailed counselling and informed consent, the patient was prepared for robotic surgery. A three-dimensional surgical plan was designed, mapping the course of the facial nerve and its branches as identified on high-resolution imaging. The patient was positioned supine with the head slightly turned to the opposite side and supported on a soft ring. The robotic console, vision cart, and patient cart were positioned ergonomically to ensure optimal access to the parotid region.

An infraclavicular approach was selected to achieve good result with a three port technique. Sub-platysmal flaps were carefully elevated to expose the parotid fascia.

Docking and Exposure

The Da Vinci Xi robot was docked with three robotic arms and one assistant port. A 30-degree dual-lens 3D high-definition endoscope provided magnified visualization, allowing exceptional clarity and depth perception. The robotic instruments used included a Maryland bipolar forceps and monopolar scissors.

The robotic system allowed precise, tremor-free movements within the limited working space of the parotid region. The magnified vision facilitated meticulous dissection of the superficial lobe while preserving vital neurovascular structures.

Facial Nerve Identification and Preservation

The critical aspect of any parotidectomy is the identification and safeguarding of the facial nerve and its branches. Under high magnification, the main trunk of the facial nerve was identified at its exit from the stylomastoid foramen, deep to the posterior belly of the digastric muscle. The robot’s wristed instruments provided exceptional dexterity to perform delicate maneuvers around the nerve branches.

Each branch—temporal, zygomatic, buccal, marginal mandibular, and cervical—was carefully dissected and preserved. The superior three-dimensional visualization allowed precise nerve mapping, reducing traction and manipulation. 

Dissection of the Superficial and Deep Lobe

The use of bipolar energy in fine bursts ensured hemostasis without thermal spread to the nerves. Throughout the procedure, meticulous attention was paid to the spatial relationship between the deep lobe and the internal carotid artery, retromandibular vein, and facial nerve branches. The robotic instruments allowed unparalleled freedom of movement in this confined anatomical space.

Specimen Retrieval and Hemostasis

Following completion of the dissection, the specimen was retrieved in a sterile endoscopic retrieval bag through the access site. Meticulous hemostasis was achieved, and a small suction drain was placed to prevent postoperative seroma formation. The incision was closed in layers with fine absorbable sutures, providing a virtually scarless aesthetic result.

Post-operative Course

The patient recovered uneventfully. There was no facial nerve weakness, confirming successful preservation of all nerve branches. Pain was minimal, and the drain was removed on the second postoperative day. The patient was discharged on the third postoperative day. On follow-up, facial nerve function remained intact, and there was no evidence of salivary fistula or Frey’s syndrome.

Discussion

Robotic surgery has expanded the horizons of head and neck oncologic procedures. The robotic-assisted parotidectomy overcomes the limitations of conventional open or endoscopic approaches by offering superior visualization, tremor filtration, and enhanced dexterity. It allows surgeons to work within narrow anatomical confines with greater precision and safety.

Several advantages of robotic-assisted parotidectomy are evident:

1. Better Cosmesis: By employing a hidden incision, the procedure leaves no visible facial scar, greatly improving patient satisfaction.

2. Enhanced Visualization: The 3D magnified vision provides unparalleled clarity for identifying the facial nerve and its branches.

3. Reduced Trauma: Gentle dissection with articulated instruments minimizes tissue handling and reduces postoperative edema and pain.

4. Oncologic Safety: The robotic system allows precise and complete excision of both superficial and deep lobes while maintaining oncologic principles.

5. Faster Recovery: Reduced postoperative pain and minimal drain requirement contribute to a shorter hospital stay.

While the learning curve is moderate, once mastered, robotic parotidectomy represents the ideal balance between oncologic safety and aesthetic precision. This pioneering surgery at GKNM Hospital marks a significant step forward in introducing minimally invasive head and neck procedures in South India.

Conclusion

The successful completion of the first robotic-assisted total parotidectomy at GKNM Hospital underscores the institution’s commitment to adopting cutting-edge technologies for cancer and complex head and neck surgeries. The procedure demonstrates that robotic surgery can achieve oncological completeness while ensuring excellent functional and cosmetic outcomes.

With the combination of surgical expertise, technological precision, and patient-centered care, robotic-assisted parotidectomy is poised to redefine standards in parotid gland surgery. This landmark case paves the way for broader applications of robotic systems in advanced head and neck oncologic surgery, offering patients safer and more refined surgical experiences.