Occipital endoscopic approach: (Iaremenko (6))
An incision was performed in the occipital hairline region from
occipital bone condylar fossa and going along the hairline 1.2 ± 0.3 cm
under it. Layer by layer incision of skin and subcutaneous tissue was
done. Fascia dissection was performed by means of unipolar and bipolar
laparoscopic tools; a “tunnel” was formed under control of a rigid
endoscope; “tunnel” vector was directed along the inferior border of
the mandible. Anterior border of sternocleidomastoid muscle was
visualized; fascia dissection under internal border of
sternocleidomastoid muscle was performed, and the muscle was elevated by
means of a retractor. Neurovascular bundle fascia was dissected and
exposed the cyst fascia with an anterior-inferior adjoining swollen
lymphatic node. In larger cysts, the cyst fascia exposed under the
internal border of sternocleidomastoid muscle. In all the cases,
aspiration of cyst fluid was performed. The fascia was clamped with
forceps and excised by means of ultrasound unipolar and bipolar
laparoscopic tools. Tube drainage was inserted into the wound on vacuum.
The wound was closed layer by layer with biodegradable synthetic loop
sutures. The skin incision was closed with polypropylene loop sutures.
The wound was covered with tight aseptic dressing.
Appendix 3 : Studies using conventional surgery for removal of
second branchial arch anomalies (including cysts, fistulas and sinus).