Balasundaram, I., I. Al-Hadad, et al. (2011). “Recent advances in reconstructive oral and maxillofacial surgery.” British Journal of Oral and Maxillofacial Surgery.
Reconstruction within the head and neck is challenging. Defects can be anatomically complex and may already be compromised by scarring, inflammation, and infection. Tissue grafts and vascularised flaps (either pedicled or free) bring healthy tissue to a compromised wound for optimal healing and are the current gold standard for the repair of such defects, but disadvantages are their limited availability, the difficulty of shaping the flap to fit the defect and, most importantly, donor site morbidity. The importance of function and aesthetics has driven advances in the accuracy of surgical techniques. We discuss current advances in reconstruction within oral and maxillofacial surgery. Developments in navigation, three-dimensional imaging, stereolithographic models, and the use of custom-made implants can aid and improve the accuracy of existing reconstructive methods. Robotic surgery, which does not modify existing techniques of reconstruction, allows access, resection of tumours, and reconstruction with conventional free flap techniques in the oropharynx without the need for mandibulotomy. Tissue engineering and distraction osteogenesis avoid the need for autologous tissue transfer and can therefore be seen as more conservative methods of reconstruction. Recently, facial allotransplantation has allowed whole anatomical facial units to be replaced with the possibility of sensory recovery and reanimation being completed in a single procedure. However, patients who have facial allotransplants are subject to life-long immunosuppression so this method of reconstruction should be limited to selected cases.
Byrd, J. K. and E. J. Lentsch (2011). “Endoscopie minimally invasive thyroidectomy: What’s new?” Otorinolaringologia 61(3): 95-99.
The aim of this paper was to review the most recent advances in minimally invasive thyroidectomy through retrospective review of the Iiterature. There are many endoscopie approaches for thyroidectomy. The most common cervical approach, minimally invasive video-assisted thyroidectomy (MIVAT), was developed by Miccoli et al. Robotic transaxillary and axillary-breast approaches avoid a neck scar and are becoming more popular. Novel approaches under investigation include facelift robotic surgery and the floor of mouth endoscopie approach. A variety of minimally invasive thyroidectomy approaches have been described in the Iiterature. MIVAT appears to be the most prevalent, with many reports in the Iiterature of good outcomes.
Friedman, M., C. Hamilton, et al. (2012). “Transoral Robotic Glossectomy for the Treatment of Obstructive Sleep Apnea-Hypopnea Syndrome.” Otolaryngology and Head and Neck Surgery.
Objective. In previous reports of transoral robotic surgery (TORS) for the treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS), patients underwent routine tracheotomy. We aim to assess the feasibility of performing robotically assisted partial glossectomy without tracheotomy and to assess efficacy by comparing OSAHS outcomes with those of established techniques.Study Design. Historical cohort study with planned data collection.Setting. Tertiary care center.Subjects and Methods. Forty consecutive patients underwent TORS for OSAHS between October 2010 and June 2011 and were followed up with regard to complications, morbidity, and subjective and objective outcomes. Data from 27 of these patients who underwent concomitant z-palatoplasty with 6-month follow-up were compared with those of 2 matched cohorts of patients, who underwent either radiofrequency (radiofrequency base-of-tongue reduction [RFBOT]) or coblation (submucosal minimally invasive lingual excision [SMILE]) reduction of the tongue base and z-palatoplasty.Results. No major bleeding or airway complications were observed. Postoperative pain and length of admission were similar between groups. All groups saw Epworth score and snore score improvement. Patients undergoing robot-assisted surgery took longer than their SMILE and RFBOT counterparts to tolerate normal diet and longer than RFBOT patients to resume normal activity. Apnea hypopnea index (AHI) reduction averaged 60.5% +/- 24.9% for TORS versus 37.0% +/- 51.6% (P = .042) and 32.0% +/- 43.3% (P = .012) for SMILE and RFBOT, respectively. Only the robotic group achieved statistically significant improvement in minimum oxygen saturation. Surgical cure rate for TORS (66.7%) was significant compared with RFBOT (20.8%, P = .001) but not compared with SMILE (45.5%, P = .135).Conclusion. Robotically assisted partial glossectomy feasibly can be performed without the need for tracheotomy. This technique resulted in greater AHI reduction but increased morbidity compared with the other techniques studied.
Fujimoto, Y., M. Hiramatsu, et al. (2011). “Transoral robotic surgery.” Oto-Rhino-Laryngology Tokyo 54(5): 349-352.
Historically, advanced oropharyngeal cancer has been treated by surgical excision and postoperative radiotherapy. In this decade, many authors advocate for chemoradiotherapy to avoid impairments after surgery. But it also induced significant impairments in swallowing. Transoral robotic surgery (TORS) provides new benchmarks of function and complication rates, with which other series of treatments for oropharyngeal SCC can be compared. In Japan, we cannot do this procedure now, but we have to prepare.
Holtel, M. R. and Y. Roth (2011). “A toy story?” Otolaryngologic Clinics of North America 44(6): xi-xiii.
Jougon, J. “New developments in surgical treatment of thyroid carcinoma in 2011.” Nouveautés dans la prise en charge chirurgicale du cancer thyroïdien en 2011.
New developments in surgical treatment of thyroid carcinoma are presented. Nowadays, the main interest of robotic surgery is to avoid skin incision in the neck by transposing it in the armpit and in the nipple. Mini-invasive surgery of the mediastinum (TEMLA, VAXY) are authentic progress. Decision making of the physicians are more standardized by standardization of fine needle aspiration biopsy and Bethesda classification. Unilateral prophylactic central lymph node dissection may be an alternative between systematic bilateral and any lymph node central dissection for thyroid carcinoma. © 2011 Elsevier Masson SAS. All rights reserved.
Kayhan, F. T., K. H. Kaya, et al. (2011). “Robot-Assisted Removal of a Posterior Pharyngeal Wall Mucoepidermoid Carcinoma.” Indian Journal of Otolaryngology and Head and Neck Surgery: 1-4.
This report presents a rare case of a mucoepidermoid carcinoma of the posterior pharyngeal wall of the hypopharynx. Excision of the lesion was performed by transoral robotic surgery (TORS). The rarity of hypopharyngeal mucoepidermoid carcinoma and the technical advantages of TORS are presented and discussed in this study. © 2011 Association of Otolaryngologists of India.
Kitano, H. (2011). “Robotic surgery using da Vinci S system in the head and neck surgery.” Oto-Rhino-Laryngology Tokyo 54(5): 353-355.
Recently, robotic technology in the surgical field has widely spread. However, in the field of head and neck surgery, robotic surgery has been limited because of spatial and technical limitations. The technical and optical advantages of new robotic instruments, da Vinci S system, enable us to perform robotic surgery in the field of head and neck. Robotic thyroid surgery using robotic surgery has been developed mainly in Korea. In Korea, robotic thyroidectomy using a gasless, transaxillary approach is a common technique. Another feasible approach in head and neck region is transoral robotic surgery (TORS) for mesopharyngeal and midline skull base tumor. This technique has been developed mainly in the United States.
Landry, C. S., D. S. Kwon, et al. (2011). “Operative technique for single incision robot-assisted transaxillary thyroid surgery.” World Journal of Endocrine Surgery 3(2): 83-88.
During the past five years, transaxillary approaches to thyroid surgery have been introduced into surgical literature. These techniques were initially performed using traditional endoscopy, and most recently with a surgical robot. This manuscript describes our approach to robot- assisted transaxillary surgery (RATS) for thyroidectomy using a single axillary incision. Because of the steep learning curve, this procedure is best implemented with a team approach. The ideal team consists of a console surgeon who operates the robot, a bedside surgeon who assists with retraction and troubleshoots robotic arm collisions and a circulating assistant who helps optimize the efficiency of the operation. © Jaypee Brothers Medical Publishers (P) Ltd.
Lee, K. E., D. H. Koo, et al. (2011). “Surgical completeness of bilateral axillo-breast approach robotic thyroidectomy: Comparison with conventional open thyroidectomy after propensity score matching.” Surgery 150(6): 1266-1274.
Background: Bilateral axillo-breast approach (BABA) robotic thyroidectomy (RoT) has good postoperative and excellent cosmetic outcomes. To assess the surgical completeness of BABA RoT, it was compared to open thyroidectomy (OT) after propensity score matching of the cohorts. Methods: Between 2008 and 2010, 760 patients who underwent total thyroidectomy with central node dissection (CND) caused by papillary thyroid carcinoma (PTC) in Seoul National University Hospital were enrolled; 327 BABA robotic and 423 open method operations were performed. We selected 174 robotic and 237 open thyroidectomy patients who received radioactive iodine (RAI) ablation. Propensity score matching using 3 demographic and 5 pathologic factors was used to generate 2 matched cohorts, each composed of 108 patients. Results: The matched BABA RoT and OT cohorts were not different with regard to the RAI uptake ratio, stimulated thyroglobulin (Tg) levels, or proportion of patients with stimulated Tg levels <1.0 ng/mL on the first ablation. The number of RAI ablation sessions and RAI doses needed to achieve a complete ablation also did not differ significantly. Conclusion: The surgical completeness of BABA RoT did not differ from OT. BABA RoT may be suitable for patients with PTC who prefer scarless neck surgery. © 2011 Published by Mosby, Inc.
Lee, S., H. R. Ryu, et al. (2012). “Early surgical outcomes comparison between robotic and conventional open thyroid surgery for papillary thyroid microcarcinoma.” Surgery.
BACKGROUND: Robotic operations have enabled a safer and more meticulous approach to thyroidectomy with the notable benefit of improved cosmesis and decreases in postoperative pain and swallowing discomfort. The aim of this study was to document the early surgical outcomes of robotic thyroidectomy in patients with papillary thyroid carcinoma (PTC) by comparing it with conventional open thyroidectomy. METHODS: From October 2007 to September 2008, 458 patients with PTC underwent thyroidectomy at the Yonsei University Health System. Of these patients, 266 patients were in the conventional open group and 192 patients were in the robotic group. These 2 groups were compared retrospectively with respect to clinicopathologic characteristics and surgical outcomes. RESULTS: The mean follow-up period was 29.1 months. Mean tumor size, incidence of capsular invasion, multiplicity, and central nodal metastasis showed no significant difference between the 2 groups. Total thyroidectomy was performed more frequently in the open group. In terms of operation times, the robotic group had a significantly greater length of time for total thyroidectomy and subtotal thyroidectomy. The total number of retrieved central lymph nodes was greater in the open group (5.7 versus 4.6, P = .004). The 2 groups showed no differences in intraoperative and postoperative complications. The postoperative serum thyroglobulin levels were similar in both groups (0.25 versus 0.22 ng/mL, P = .648) and 2-year follow-up sonography of 433 patients revealed no recurrences. No abnormal I(131) uptake was observed in whole-body scans in either group. CONCLUSION: Robotic thyroidectomy was similar to conventional open thyroidectomy in terms of early surgical outcomes but offers advantages. We conclude that robotic thyroidectomy offers a safe, feasible alternative to conventional open thyroidectomy in patients with PTC.
Moore, E. J. and D. L. Price (2011). “Current role of robotic surgery in head and neck cancer.” Otorinolaringologia 61(3): 89-94.
During the last decade, robotic surgery has evolved from a novelty with anticipated potential to the preferred surgical procedure in multiple surgical disciplines such as urology, gynecology, thoracic surgery, cardiothoracic surgery, and gastrointestinal surgery. The evolution of robotic surgery in head and neck surgery has expanded on the success of transorai surgery with other modalities to remove head and neck tumors. This article reviews the evolution of head and neck robotic surgery, the current instrumentation and capabilities, and the anticipated future applications.
O’Neill, J. P. and C. Timon (2011). “Prospective assessment of postoperative pain in patients undergoing minimally invasive video-assisted versus minimally invasive open thyroidectomy.” World Journal of Endocrine Surgery 3(1): 11-14.
Introduction: Reduced invasiveness has a potential benefit of reduced postoperative pain however there is a relative paucity of prospective data to confirm this presumption. The analysis of this prospective study was to compare pain score results in patients who underwent minimally invasive video-assisted (MIVAT) versus minimally invasive open thyroidectomy (MIT) and in doing so further extrapolate the potential advantages of video-assisted thyroid surgery. Materials and methods: A total of 98 patients post minimally invasive thyroidectomy from January 1st to December 31st 2008 are the subject matter of this study. Pain scores (0-10) assigned by the patients shortly after the thyroidectomy and after 24 hours postoperative forms the basic outcome variable. For statistical comparison of the distributions of the pain scores between patients the KolmogrovSmirnov (KS) test was employed. Results: The comparison pain score distribution using the KS test for postoperative assessment yielded a Z-value of 2.84 (P < 0.001). The comparison pain score distribution at 24 hours yielded a Z-value of 1.48 (P < 0.05). These results imply the difference in distributions of pain scores among MIT and MIVAT group to be statistically significant. Conclusions: We concluded that video-assisted thyroidectomy appears to reduce the pain in patients shortly after the operation and 24 hours postoperative. The reduction is statistically significant. Male patients appear to report less pain compared to their female counter parts. © Jaypee Brothers Medical Publishers (P) Ltd.
Park, Y. M., W. S. Kim, et al. (2012). “Transoral robotic surgery for hypopharyngeal squamous cell carcinoma: 3-Year oncologic and functional analysis.” Oral Oncology.
The recent trend in treatment of hypopharyngeal cancer is organ preservation in order to maintain swallowing and speech function as well as improve quality of life. Transoral robotic surgery (TORS) can remove hypopharyngeal lesions successfully without an external incision, preserving physiologic functions of affected organs. However, studies have yet to assess the oncologic and functional results of TORS for the treatment of hypopharyngeal cancer. This prospective study evaluated the oncologic and functional results of TORS for the treatment of hypopharyngeal cancer obtained at our institution over a period of 3years and confirmed the validity of TORS as a surgical organ-preserving strategy. Between April 2008 and September 2011, 23 patients who were diagnosed with hypopharyngeal cancer underwent TORS for removal of a primary lesion. The da Vinci Robotic system (Intuitive Surgical Inc., Sunnyvale, California) was used to remove the lesion. The Kaplan-Meier method was used to analyze overall survival and disease-free survival. Videopharyngogram study (VEF) was performed and functional outcome swallowing scale (FOSS) was utilized to measure and evaluate swallowing function. Acoustic wave form analysis was conducted to evaluate voice status. Overall survival at 3years was 89% and disease-free survival was 84%. On the VEF study, serious aspiration or delay of swallowing was not observed during the pharyngeal stage of the swallowing process. Overall, 96% of the patients showed favorable swallowing abilities with an FOSS score ranging from 0 to 2. The fundamental frequency variation (vF0) and jitter were increased upon acoustic waveform analysis (vF0=2.71+/-0.063, Jitter=2.01+/-0.034), but the harmonic-to-noise ratio (HNR) and shimmer were maintained close to the normal range (HNR=1.28+/-0.001, Shim=1.74+/-0.036). The oncologic and functional results of TORS were quite acceptable for the treatment of hypopharyngeal cancer. TORS is a valid treatment option as a surgical, organ-preserving strategy for select patients with hypopharyngeal cancer.
Shin, Y. S., H. J. Hong, et al. (2012). “Gasless transaxnillary robot-assisted neck dissection: A preclinical feasibility study in four cadavers.” Yonsei Medical Journal 53(1): 193-197.
Purpose: We hypothesized that comprehensive neck dissection could be achieved via a gasless transaxillary approach using a robotic system. We intended to evaluate the accessibility of level I, IIB and VA nodes with transaxillary robot-assisted neck dissection of four cadavers. Materials and Methods: Transaxillary robotic neck dissection was performed in four cadavers through a 7-cm longitudinal incision at the anterior axilla and a 0.8-cm-sized incision in the chest wall. Results: We successfully performed neck dissection from level II to V in all four cadavers. However, dissection of levels IIB and VA, which lie on the cephalic portion of the spinal accessory nerve, was difficult. Vital structures, including the internal jugular vein, carotid artery, vagus nerve, phrenic nerve, superior thyroid artery and hypoglossal nerve, were successfully identified and preserved. Conclusion: Our results demonstrate the feasibility of robot-assisted neck dissection using a transaxillary approach. We suggest that gasless, transaxillary robotic neck dissection is a promising technique for treating nodal metastasis in thyroid cancers or in selected squamous cell carcinomas of the head and neck. However, some modification of the approach might be needed when performing comprehensive neck dissections of all levels of the neck.
Tae, K., K. Y. Kim, et al. (2011). “Functional voice and swallowing outcomes after robotic thyroidectomy by a gasless unilateral axillo-breast approach: comparison with open thyroidectomy.” Surgical Endoscopy.
BACKGROUND: Voice and swallowing alterations are common complaints after thyroidectomy, even in the absence of laryngeal nerve impairment. However, voice and swallowing functions after robotic thyroidectomy have not been thoroughly investigated. This study compared the functional outcomes for voice and swallowing after robotic thyroidectomy and conventional open thyroidectomy. METHODS: The study prospectively analyzed the voice and swallowing functions of patients with thyroid nodules who underwent robotic thyroidectomy by a gasless unilateral axillo-breast (GUAB) approach (50 cases) or by conventional open thyroidectomy (61 cases) from September 2009 to October 2010. Videolaryngostroboscopy or flexible laryngoscopy was performed pre- and postoperatively. Subjective voice and swallowing alterations were assessed by questionnaire preoperatively and then 1 day, 1 week, 1 month, 3 months, and 6 months postoperatively. In addition, objective acoustic voice analysis was performed using a Multidimensional Voice Program, with Voice Range Profiles and maximum phonation times measured preoperatively and then 1 week, 1 month, 3 months, and 6 months postoperatively. RESULTS: Subjective postoperative voice function was significantly better in the robotic group at 1 day, 1 month, and 3 months postoperatively than in the open group. The mean values of fundamental frequency, jitter, shimmer and noise-to-harmonic ratio before and after surgery did not differ between the two groups. However, the frequency range and the highest frequency were significantly better in the robotic group than in the open group at 3 months postoperatively. Subjective swallowing function did not differ between the two groups. CONCLUSION: Postoperative voice function is better with robotic thyroidectomy using the GUAB approach than with conventional open thyroidectomy. This is an advantage of robotic thyroidectomy by the GUAB approach in addition to the excellent cosmesis.
Head & Neck|Single Port (1)
Landry, C. S., D. S. Kwon, et al. (2011). “Operative technique for single incision robot-assisted transaxillary thyroid surgery.” World Journal of Endocrine Surgery 3(2): 83-88.
During the past five years, transaxillary approaches to thyroid surgery have been introduced into surgical literature. These techniques were initially performed using traditional endoscopy, and most recently with a surgical robot. This manuscript describes our approach to robot- assisted transaxillary surgery (RATS) for thyroidectomy using a single axillary incision. Because of the steep learning curve, this procedure is best implemented with a team approach. The ideal team consists of a console surgeon who operates the robot, a bedside surgeon who assists with retraction and troubleshoots robotic arm collisions and a circulating assistant who helps optimize the efficiency of the operation. © Jaypee Brothers Medical Publishers (P) Ltd.