“Transoral Robotic Surgery of the Vocal Cord.”
Blanco, R. G., P. K. Ha, et al. (2011).
Journal of Laparoendoscopic and Advanced Surgical Techniques. Part A.
Abstract The standard endoscopic surgical approach in the management of laryngeal lesions is by the use of a laryngoscope, microscope, and laser. This requires the surgeon to work within the confines of the laryngoscope. At times, it requires repositioning of the laryngoscope and microscope to gain access to a specific area. The surgery also requires line-of-sight observation to complete the operation. The introduction of transoral robotic surgery in head and neck surgery brings the advantages of three-dimensional magnification, increased degrees of freedom with the effector arms, and an articulating distal end that mimics hand movements. To date, transoral robotic surgery of vocal cord surgery requires the use of a tracheostomy in patients. Here we report the use of a CO(2) laser fiber and the Da Vinci robotic platform (Intuitive Surgical) for the surgical management of a T1 glottic squamous cell carcinoma.
“Salvage surgery for upper aerodigestive tract tumours.”
Dolivet, G., S. Cortese, et al. (2011).
Chirurgie de rattrapage dans les tumeurs des VADS 98(1): 59-71.
Salvage surgeries of head and neck tumors are considered as poor satisfactory either for disease control results or for aesthetic and functional outcomes. Several improvements have been made possible since few years in all fields of oncologic treatments. A new approach must be initiated in that context, moreover since take in charge for head and neck region (exclusive initial medical treatment) let us consider an increasement of clinical situations for which a salvage therapy could be performed. The new surgery techniques have to be considered, reconstructive and guided by systems, which can improve surgical skills (navigation, robotic, sentinel node procedure, nervous detection and so on), the help of reirradiation techniques, the use of medical therapy during surgical procedure, the photodynamic therapy and all the help provided by new medical imaging and modern biology, which can determine more precisely the status of the cancer when it is taken in charge. The mastery of those techniques improvements must follow on an evolution of the concepts in the field of combined salvage treatments performed by multidisciplinary teams. Those treatments have to be realized in structures, which have the techniques and the multiple skills for allowing increasement of outcomes of those severe diseases.
“The role of reconstruction for transoral robotic pharyngectomy and concomitant neck dissection.”
Genden, E. M., R. Park, et al. (2011).
Archives of Otolaryngology–Head and Neck Surgery 137(2): 151-156.
OBJECTIVE: To evaluate the impact of primary reconstruction of postablative defects following transoral robotic surgery on function and the risk of orocutaneous fistula. DESIGN: Prospective nonrandomized clinical trial. SETTING: Tertiary academic medical center. PATIENTS: Thirty-one patients treated with transoral robotic pharyngectomy for malignant disease. Each case was analyzed for patient age, sex, primary site of the tumor, pathologic characteristics, stage of disease, complications, fistula rate, and functional outcomes. Functional outcomes were assessed using the Performance Status Scale for Head and Neck Cancer Patients and the Functional Oral Intake Scale. INTERVENTIONS: In 25 patients, the primary treatment was with transoral robotic pharyngectomy, and 6 cases were salvage procedures performed for recurrent disease following radiation (3 patients) or chemoradiation (3 patients). Twenty-six patients underwent a concomitant unilateral selective neck dissection, and 3 patients underwent concomitant bilateral selective neck dissections; 2 patients did not require a neck dissection for treatment of the primary malignant tumor. MAIN OUTCOME MEASURES: Complication rate, fistula rate, and oral function. RESULTS: Primary intraoral reconstruction was performed in all 31 patients. Musculomucosal advancement flap pharyngoplasty was performed in 25 patients with a concomitant velopharyngopasty (6 patients), and radial forearm free flap reconstruction was performed in 6 patients. There were no intraoperative complications; however, postoperatively, 1 patient developed a neck hematoma that was treated with bedside drainage and 4 patients sustained minor musculomucosal flap necrosis of the superior aspect of the flap. None of the patients developed a neck infection of salivary fistula. Endoscopic evaluation of swallowing demonstrated that none of the patients experienced aspiration or velopharyngeal reflux, and the performance Status Scale for Head and Neck Cancer Patients and the Functional Oral Intake Scale at 2 weeks, 2 months, 6 months, 9 months, and 1 year demonstrated a progressive improvement in diet, swallowing, and oral function. CONCLUSIONS: Primary transoral robotic reconstruction may provide a benefit by decreasing the fistula rate in patients undergoing concomitant neck dissection. Patients regain excellent function following surgery and adjuvant therapy.
“Transoral robotic-assisted microvascular reconstruction of the oropharynx.”
Ghanem, T. A. (2011).
Laryngoscope 121(3): 580-582.
“Robotic thoracoscopic mediastinal parathyroidectomy for persistent hyperparathyroidism: case report and review of the literature.”
Harvey, A., L. Bohacek, et al. (2011).
Surgical Laparoscopy, Endoscopy and Percutaneous Techniques 21(1): e24-27.
Recurrent and persistent primary hyperparathyroidism remains a significant surgical challenge. Abnormal, hypersecreting parathyroid glands are found in ectopic locations in up to 15% to 20% of patients. A small portion of these ectopic glands will be found in the mediastinum at a location that precludes removal through the traditional cervical incision. Minimally invasive approaches to these glands are desirable because of the significant morbidity, pain, and hospital stay associated with sternotomy or thoracotomy. Recently, robotic approaches have been described for mediastinal parathyroids. We report a case of young woman with persistent primary hyperparathyroidism who was cured after undergoing robotic thoracoscopic mediastinal parathyroidectomy using radiooperative and intraoperative parathyroid hormone guidance.
“Rupture of endotracheal tube cuff during robot-assisted endoscopic thyroidectomy – A case report.” Lee, H. C., M. J. Yun, et al. (2010).
Korean Journal of Anesthesiology 59(6): 416-419.
We encountered a case of a rupture of an endotracheal tube cuff during robot-assisted thyroid surgery in a 35-year-ld male patient. Two hours after commencing surgery, the bellows of the ventilator were not filled and a rupture of the endotracheal tube cuff was suspected. Once the robot-manipulator is engaged, the position of the operating table cannot be altered without removing it from the patient. Reintubation with direct laryngoscopy was performed with difficulty in the narrow space between the patient’s head and robot-manipulator without moving the robot away from the patient. The rupture of the endotracheal tube cuff was confirmed by observing air bubbles exiting from the balloon in water. The patient was discharged 3 days after surgery without complications. In robot-assisted thyroid surgery, a preoperative arrangement of the robot away from the patient’s head to obtain easy access to the patient is essential for safe anesthetic care. Copyright © Korean Society of Anesthesiologists, 2010.
“Transoral robotic photodynamic therapy for the oropharynx.”
Quon, H., J. Finlay, et al. (2011).
Photodiagnosis Photodyn Ther 8(1): 64-67.
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.
“A new technique for robotic thyroidectomy: “the daVinci gasless single-incision axillary approach”.”
Rodriguez, F. N. S., R. A. Low, et al. (2011).
Journal of Robotic Surgery: 1-6.
Robotic thyroidectomy has been recently introduced as a new modality of treatment for selected benign and malignant thyroid lesions. The standard technique, popularized by a leading Korean group, combines an axillary and a thoracic approach to accomplish thyroid resection without neck incision. We recently introduced a modified technique that has enabled us to complete robotic thyroidectomy through a single axillary incision. We herein report our initial successful experience in 35 cases with the modified technique. © 2011 Springer-Verlag London Ltd.