“Transoral Robotic Surgery for the Treatment of Head and Neck Cancer of Various Localizations.”
Aubry, K., M. Yachine, et al. (2011).
Surgical Innovation.
Background. Transoral robotic surgery (TORS) is a recent endoscopic technique to resect selected head and neck cancers. Study design. In total, 13 patients underwent TORS procedure for resection of head and neck cancers of various localizations, within the ENT Department of Limoges University Hospital Center between March and October 2010. Results. Tumor localizations were aryepiglottic fold (n = 3), pyriform sinus (n = 2), posterior pharyngeal wall (n = 2), base of tongue (n = 2), lateral pharyngeal wall (n = 2), vallecula (n = 1), and epiglottis (n = 1). Average TORS setup time was 23 minutes. Average TORS operative time was 45 minutes. Average hospital stay was 8.4 days. Conclusions. TORS is a new technique that permits excellent resection of selected head and neck cancers with poor morbidity. Future reports on long-term oncologic and functional outcomes are needed to assess the risks and benefits of this approach compared with external approaches and nonsurgical alternatives.
“Transoral robotic resection and reconstruction for head and neck cancer.”
Genden, E. M., T. Kotz, et al. (2011).
Laryngoscope 121(8): 1668-1674.
OBJECTIVES/HYPOTHESIS: To evaluate the patterns of failure, survival, and functional outcomes for patients treated with transoral robotic surgery (TORS) and compare these results with those from a cohort of patients treated with concurrent chemoradiation (CRT). STUDY DESIGN: Prospective non-randomized case control study. METHODS: Between April 2007 and April 2009, 30 patients with head and neck squamous cell carcinoma were treated with primary TORS and adjuvant therapy as indicated on an institutional review board-approved protocol. Patients were evaluated before treatment, after treatment, and at subsequent 3-month intervals after completing treatment to determine their disease and head and neck-specific functional status using the Performance Status Scale for Head and Neck Cancer and the Functional Oral Intake Score (FOIS). Functional scores were compared to a matched group of head and neck patients treated with primary CRT. RESULTS: The TORS patient population included 73% stage III-IV and 23% nonsmokers. The median follow-up was 20.4 months (range, 12.8-39.6 months). The 18-month locoregional control, distant control, disease-free survival, and overall survival were 91%, 93%, 78%, and 90%, respectively. Compared to the primary CRT group, TORS was associated with better short-term eating ability (72 vs. 43, P = .008), diet (43 vs. 25, P = .01), and FOIS (5.5 vs. 3.3, P < .001) at 2 weeks after completion of treatment. In contrast to TORS patients who returned to baseline, the CRT group continued to have decreased diet (P = .03) and FOIS (P = .02) at 12 months. CONCLUSIONS: Our early experience in treating selected head and neck cancers with TORS is associated with excellent oncologic and functional outcomes that compare favorably to primary CRT.
“Minimally invasive thyroidectomy: A comprehensive appraisal of existing techniques.”
Linos, D. (2011).
Surgery 150(1): 17-24.
“Early post-operative function after transoral robotic surgery.”
Loyo, M., N. Agrawal, et al. (2011).
Laryngoscope 121(SUPPL. 4).
OBJECTIVES: To describe the early post-operative course of patients undergoing transoral robotic surgery (TORS). Study Design: Prospective cohort study Methods: Early measures of speech and swallow function by speech-language pathologists were recorded on our first 20 patients undergoing TORS on post-operative day (POD) 1. Results: All patients underwent TORS for oropharyngeal tumors (T1-T4). All patients were extubated before POD 2. All patients had fully intelligible speech post-operatively and did not need assistive communication devices. No patients required tracheotomies. Three patients had percutaneous endoscopic gastrostomy tubes placed in anticipation of chemoradiation. All patients were discharged home tolerating liquid or soft diets. One patient was treated in the emergency room for postoperative dehydration that responded to IV fluids and one patient had a post-operative pneumonia. Neither of these patients required readmission or placement of feeding tubes. Conclusions: Early post-operative speech and swallow function in patients undergoing TORS for oropharyngeal tumors is excellent with immediate return to oral intake and fully intelligible speech.
“Transoral robotic surgery (TORS) for parapharyngeal and retromolar trigone tumors.”
Luginbuhl, A., A. Nguyen, et al. (2011).
Laryngoscope 121(SUPPL. 4).
“Detection of brachial plexopathy during transaxillary robotic thyroidectomy.”
Luginbuhl, A., D. Schwartz, et al. (2011).
Laryngoscope 121(SUPPL. 4).
“Laryngeal Advanced Retractor System: A New Retractor for Transoral Robotic Surgery.”
Remacle, M., N. Matar, et al. (2011).
Otolaryngology and Head and Neck Surgery.
“A pharmacokinetic approach to rapidly titrate propofol during drug-induced sleep endoscopy for evaluation of sleep apnea prior to transoral robotic tongue base surgery.”
Sperry, S. M., J. E. Mandel, et al. (2011).
Laryngoscope 121(SUPPL. 4).
OBJECTIVES: To describe a method for performing drug-induced sleep endoscopy on severe sleep apnea patients, utilizing a rapid titration of propofol with real-time calculation of maintenance dose infusions to quickly reach and maintain a goal of moderate airway obstruction. Study Design: Case series Methods: Sleep apnea patients undergoing initial screening for possible surgical intervention via transoral robotic surgery were taken to the operating room for sleep endoscopy as part of a prospective trial. The patients were induced with a novel propofol infusion sequence, which was rapidly titrated to an endpoint level of sedation producing moderate obstruction, based on computer modeling performed in realtime. Standard intraoperative monitoring parameters were recorded and analyzed. Results: In this series, 17 patients underwent sleep endoscopy. Each achieved sedation with a propofol infusion rate calculated in real-time by a software program and targeted to a specific clinical effect. 16/17 patients completed the endoscopy without a chin lift or jaw thrust performed to correct complete obstruction. The procedure allowed an assessment of the anatomic location of obstruction in all patients. Conclusion: Titration of propofol to precise pharmacodynamic endpoints with software utilizing a pharmacokinetic model shows promise in simplifying and standardizing the challenging task of inducing and maintaining airway obstruction during sleep endoscopy, while making an accurate assessment of the location of obstruction in sleep apnea patients.
“Robotic facelift thyroidectomy: A novel remote access thyroidectomy technique.”
Terris, D. J., M. C. Singer, et al. (2011).
Laryngoscope 121(SUPPL. 4).
OBJECTIVES: Robotic thyroidectomy accomplished by an axillary route has been associated with a number of dramatic complications. We introduce an access method that is less dangerous, easier to perform, and more direct. Methods: A facelift approach to the thyroid compartment is described. Results: Advantages of the facelift approach over the axillary approach include: easier positioning (without the risk of brachial plexopathy), shorter distance to the thyroid bed, no chest wall numbness, clavicle is not obstructing, carotid sheath at much lower risk of injury. Conclusions: We describe a safer and easier robotic technique that involves a facelift incision and therefore maintains the advantages of no neck incision, but without the increased risks associated with an axillary approach.
“Robotic facelift thyroidectomy: II. Clinical feasibility and safety.”
Terris, D. J., M. C. Singer, et al. (2011).
Laryngoscope 121(8): 1636-1641.
OBJECTIVES: A number of remote access thyroidectomy techniques have been described in the last several years. These approaches are technically challenging, can be performed on only a limited patient population, and have been associated with significant complications. We describe a novel robotic facelift approach for thyroidectomy and report our initial clinical experience. DESIGN: Planned analysis of a prospectively maintained database with institutional review board approval. METHODS: Robotic facelift thyroidectomy (RFT) was performed on all patients. Demographic and surgical data were obtained and analyzed. Data collected included patient age, gender, body mass index (BMI), pathology, complications, and duration of surgery. RESULTS: A total of 18 RFT procedures were undertaken in 14 patients. There were 13 females and 1 male, with a mean age of 33.7 +/- 18.1 years (range: 12-70). The mean BMI was 26.9 +/- 4.5. The procedures included 13 lobectomies, one bilateral thyroidectomy, and 3 completion thyroidectomies. All but the first procedure was performed on an outpatient basis without use of a drain. There were no conversions to open surgery, no permanent nerve injuries, and no cases of hypoparathyroidism. Operative times ranged from 97 to 193 minutes. CONCLUSIONS: RFT is a feasible remote access thyroidectomy approach. It appears from our initial experience that it may be performed in a safe and reproducible manner without a drain and on an outpatient basis. Additional clinical experience is warranted to further validate this technique.
“Robotic-assisted transoral removal of a bilateral floor of mouth ranulas.”
Walvekar, R. R., G. Peters, et al. (2011).
World Journal of Surgical Oncology 9(1): 78.
ABSTRACT: OBJECTIVE: To describe the management of bilateral oral ranulas with the use of the da Vinci Si Surgical System and discuss advantages and disadvantages over traditional transoral resection. Study Design: Case Report and Review of Literature. RESULTS: A 47 year old woman presented to our service with an obvious right floor of mouth swelling. Clinical evaluation and computerized tomography scan confirmed a large floor of mouth ranula on the right and an incidental asymptomatic early ranula of the left sublingual gland. After obtaining an informed consent, the patient underwent a right transoral robotic-assisted transoral excision of the ranula and sublingual gland with identification and dissection of the submandibular duct and lingual nerve. The patient had an excellent outcome with no evidence of lingual nerve paresis and a return to oral intake on the first postoperative day. Subsequently, the patient underwent an elective transoral robotic-assisted excision of the incidental ranula on the left sublingual gland. CONCLUSION: We describe the first robotic-assisted excision of bilateral oral ranulas in current literature. The use of the da Vinci system provides excellent visualization, magnification, and dexterity for transoral surgical management of ranulas with preservation of the lingual nerve and Wharton’s duct with good functional outcomes. However, the use of the robotic system for anterior floor of mouth surgery in terms of improved surgical outcomes as compared to traditional transoral surgery, long-term recurrence rates, and cost effectiveness needs further validation.