Abstrakt ORL Leden 2011

“Clinical Applications of Telerobotic ENT-Head and Neck Surgery.”

Arora, A., A. Cunningham, et al. (2011).

International Journal of Surgery.


OBJECTIVE: To review the published clinical data in Telerobotic ENT-Head and Neck surgery, evaluate the benefit of existing clinical applications and identify areas for potential development. METHODS: A qualitative review was performed of publications in PubMed, Medline and the Cochrane Database identified from the following keyword searches: Telerobotic/Robotic ENT, Otorhinolaryngology, Head and Neck surgery, Thyroid and Parathyroid surgery. Preclinical studies and non clinical review articles were excluded. RESULTS: Forty five publications were identified including 7 review articles. Transoral robotic surgery (TORS) was reported in 20 clinical studies, robotic-assisted thyroidectomy in 13 studies, parathyroidectomy in 4 studies and skull base surgery in 1 study. The majority of TORS publications relate to oropharyngeal malignancy which were Stage III and IV. Clinical benefits include avoidance or dose reduction of adjuvant chemo-radiotherapy and improved swallow function. The primary clinical advantage of robotic assisted neck surgery is the avoidance of a neck scar. The learning curve for robotic thyroidectomy is 50 cases. Body habitus is an important factor for assessement of robotic feasibility in transoral and neck surgery. CONCLUSION: The application of robotic assisted parathyroidectomy, thyroidectomy and transoral head and neck surgery (TORS) suggests promising improvements in patient care. Randomised control trials are needed to assess clinical outcome, cost effectiveness and patient benefit in the existing applications. Continued development of robotic technology will expand the viable clinical applications in this specialty.




“Thyroidectomy incision using a novel anatomic landmark method.”

Cannon, C. R. (2010).

Laryngoscope 120(SUPPL. 4).




“The evolution of robotic thyroidectomy: from inception to neck dissection.”

Chung, W. Y. (2011).

Journal of Robotic Surgery: 1-7.


Over the past decade, the application of surgical robotics is bringing about dramatic changes in various surgical fields. Robotic thyroidectomy has achieved safe and accurate management of thyroid disease with remarkable cosmetic and functional benefits. As experiences with robotic techniques accumulate, its indications will expand to include more advanced cases with higher levels of difficulty. © 2011 Springer-Verlag London Ltd.




“Is Robotic Surgery Superior to Endoscopic and Open Surgeries in Thyroid Cancer?”

Kim, W. W., J. S. Kim, et al. (2011).

World Journal of Surgery: 1-6.


Background: Endoscopic thyroidectomies have been performed using various approaches, and indications have expanded with the development of new surgical techniques and instruments. Endoscopic thyroid surgery using bilateral axillo-breast approaches have excellent cosmetic results and a symmetrical, optimal operative view. However, because of the two-dimensional view and the nonflexible instruments, these approaches are not easy to use in performing a central lymph node dissection (CND). Robotic surgery has drawn attention as a potentially safe and effective method for treating thyroid cancer. The aim of the present study was to determine whether robotic surgery is superior to endoscopic and open surgery through comparing technical aspects and surgical outcomes. Methods: From October 2008 to December 2009, 302 patients had total thyroidectomies and CND with cancer less than 1 cm. Patients were divided into three groups according to operation methods (open group; n = 138), (endo group; n = 95), (robot group; n = 69). Results: Young patients preferred the robotic and endoscopic surgery. The number of retrieved lymph nodes in the open group (4.8 ± 2.8) was not different from the robot group (4.7 ± 2.7) and the endo group (4.6 ± 3.7). The operative time of the robot group was longer than the open and the endo group. The total drain amount in the robot group was more than the open and endo groups; however, there was no difference in the length of hospitalization and complication rates. There were no differences between the open (0.8 ± 2.0) and robot groups (0.8 ± 1.4), but the endo group (2.4 ± 6.3) showed higher postoperative serum thyroglobulin off thyroid hormone (Off-Tg) when compared to the open and robot groups. Conclusions: Robotic surgery was equal to open surgery except with respect to operative time and was superior to endoscopic surgery in Off-Tg levels presenting completeness of the operation in thyroid cancer surgery. Because it has excellent cosmetic results and various technical advantages, it should be considered in young, low-risk patients with thyroid carcinoma less than 1 cm. © 2011 Société Internationale de Chirurgie.




“Transoral robotic surgery: applications and limitations.”

Mallet, Y., A. Benlyazid, et al. (2010).

La chirurgieminimale invasive transorale robot-assistée: quelles applications ? Quel avenir ?: 1-5.


Transoral robotic surgery (TORS) is a new technique that provides several unique advantages, which include a three-dimensional magnified view, the ability to see and work around curves or angles, and the availability of two or three robotic arms. Via this review of the literature, we discuss the limits and future prospects on this topic. Preliminary data suggest that TORS may provide a technique for ablation and reconstruction of pharyngeal defects with promising new transoral indications. It may also provide new opportunities of transoral surgery for oropharyngeal and supraglottic carcinoma. TORS is a promising surgical procedure contingent on the development of new associated functions such as an image guidance system. Successful development of this new tool will also depend on the quality of clinical works and research programs. © 2010 Springer Verlag France.




“Concurrent neck dissection and transoral robotic surgery.”

Moore, E. J., K. D. Olsen, et al. (2011).



OBJECTIVES:: 1) Determine the incidence of pharyngocutaneous fistula associated with transoral robotic oropharyngectomy with concurrent neck dissection. 2) Discuss prevention and treatment of pharyngocutaneous fistulization as a consequence of transoral oropharyngeal surgery with concurrent neck dissection. METHODS:: Retrospective, single-institution chart review of 148 consecutive patients who underwent transoral robotic surgery with synchronous neck dissection for oropharyngeal neoplasia April 2007 to February 2010. RESULTS:: Forty-two of 148 (29%) patients were identified as having an orocervical communication intraoperatively. All were managed with some combination of primary closure, local tissue advancement, fibrin glue application, and cervical drain placement. Of these, six (4%) developed a subcutaneous pharyngeal fluid accumulation requiring postoperative management via controlled incision and drainage with daily packing placement. All the patients had aesthetic and functional results comparable to those patients who did not have/develop an orocervical communication. No patients experienced a delay from their operative treatment that prevented them from initiating recommended adjuvant therapy on schedule. CONCLUSIONS:: Transoral robotic surgery is emerging as a primary treatment modality for oropharyngeal malignancies. Neck dissection is a required portion of operative therapy in many of these patients, and many surgeons delay neck dissection to prevent pharyngocutaneous fistula. Pharyngeal communication with the neck is a common occurrence during transoral surgery when it is combined concurrently with neck dissection, but persistent fistula formation is an uncommon, preventable, but potentially problematic, complication resulting from this operative technique. Prompt recognition and intervention are of paramount importance in preventing acute, long-term functional impairment. Laryngoscope, 2010.




“Excision of a recurrent oropharyngeal malignant lesion utilizing a minimally invasive transoral robotic surgical (TORS) technique.”

Olarte, L., K. Dhir, et al. (2010).

Laryngoscope 120(SUPPL. 3).


EDUCATIONAL OBJECTIVE A comparison of open surgical techniques with minimally invasive techniques for the management of recurrent oropharyngeal lesions. OBJECTIVES The morbidity associated with open surgical approaches for the management of oropharyngeal lesions has led to minimally invasive techniques such as the transoral robotic surgery (TORS) in lieu of a mandibulotomy approach. There is a paucity of literature outlining its use for recurrent lesions. STUDY DESIGN Case report and literature review. METHODS A 78 year old male with multiple medical problems presented with a third recurrence of an oropharyngeal malignancy. The primary oropharyngeal malignancy was treated with radiation therapy. He subsequently underwent a partial glossectomy and pharyngectomy with free flap reconstruction for multiple recurrences. Finally, a TORS was performed for excision of a third recurrence. The operative course, length of hospital stay and postoperative follow-up was recorded. RESULTS The patient underwent a TORS excision of an oropharyngeal recurrence without complications. Frozen section histology demonstrated negative margins intraoperatively. An oral diet was commenced on hospital day 1 and he was discharged on hospital day 3. CONCLUSIONS The TORS technique has proven to be a minimally invasive surgical option for tumors of the oropharyngeal region. We present its use for the treatment of recurrent lesions with encouraging results. Copyright © 2010 The American Laryngological, Rhinological, and Otological Society, Inc.




“Robotic surgery helps preserve speech after head and neck cancer surgery.”

Printz, C. (2011).

Cancer 117(3): 439.




“Transoral robotic photodynamic therapy for the oropharynx.”

Quon, H., J. Finlay, et al. (2011).

Photodiagnosis and Photodynamic Therapy.


Photodynamic therapy (PDT) has been used for head and neck carcinomas with little experience in the oropharynx due to technical challenges in achieving adequate exposure. We present the case of a patient with a second right tonsil carcinoma following previous treatment with transoral robotic surgery (TORS) and postoperative chemoradiation for a left tonsil carcinoma. Repeat TORS for the right tonsil carcinoma reviewed multiple positive surgical margins. The power output from the robotic camera was modified to facilitate safe intraoperative three dimensional visualization of the tumor bed. The robotic arms facilitated clear exposure of the tonsil and tongue base with stable administration of the fluence. Real-time measurements confirmed stable photobleaching with augmentation of the prescribed light fluence secondary to light scatter in the oropharynx. We report a potential new role using TORS for exposure and accurate PDT in the oropharynx. © 2011.




“Robotic axillary thyroidectomy: Multi-institutional clinical experience with the daVinci.”

Seybt, M., R. B. Kuppersmith, et al. (2010).

Laryngoscope 120(SUPPL. 4).