“Anesthetic considerations for transoral robotic surgery.”
Chi, J. J., J. E. Mandel, et al. (2010).
Anesthesiology Clinics 28(3): 411-422.
During the past decade, robotic surgery has been progressively incorporated into the mainstream of cardio-thoracic and abdominopelvic surgery. With the recent US Food and Drug Administration approval of transoral robotic surgery (TORS) for the treatment of all benign tumors and select malignant tumors of the head and neck, robotic surgery has established its place in otolaryngologic surgery. Given the multispecialty applications and widespread use of robotic surgery, there exists a need for anesthesiologists to familiarize themselves with robotic surgery. This article focuses on TORS and the goal of which is to provide the anesthesiologist with a foundation for caring for the TORS patient in the perioperative period.
“Transoral robotic surgery: disruptive or sustaining innovation?”
Couch, M. E. and A. Zanation (2010).
Archives of Surgery 145(9): 907-908.
“Transoral robotic resection of recurrent nasopharyngeal carcinoma.”
Wei, W. I. and W. K. Ho (2010).
Laryngoscope 120(10): 2011-2014.
Transoral robotic nasopharyngectomy was carried out for a patient who developed recurrent nasopharyngeal cancer after radiotherapy. The tumor in the left lateral wall of the nasopharynx was exposed after splitting the soft palate and a curative resection, including the medial crus of the eustachian tube was carried out under the three-dimensional 0 degrees camera. The operative procedure was uncomplicated, blood loss was minimal and the patient recovered smoothly. The camera of the surgical robot provided superb visualization of the operative field and the maneuverability of the robotic arms with the Endowrist design allowed adequate tumor extirpation. The morbidity associated with the procedure was minimal, and this surgical procedure can be applied for resection of small and favorably located residual or recurrent nasopharyngeal cancer or other appropriate pathologies in the region. Laryngoscope, 2010.
“Selective neck dissection and deintensified postoperative radiation and chemotherapy for oropharyngeal cancer: A subset analysis of the University of Pennsylvania transoral robotic surgery trial.”
Weinstein, G. S., H. Quon, et al. (2010).
Laryngoscope 120(9): 1749-1755.
Objectives/Hypothesis: The purpose of this study was to determine the regional recurrence rate of node-positive oropharyngeal squamous cell carcinoma (OPSCC) in patients undergoing transoral robotic surgery (TORS) and selective neck dissection (SND) followed by observation, radiation, or concurrent chemoradiation. Study Design: A prospective, phase I, single-arm study was conducted. All OPSCC patients who voluntarily participated in a surgical trial with TORS and SND at an academic tertiary referral center from May 2005 to July 2007 were included. Methods: Thirty-one patients with previously untreated OPSCC undergoing TORS and SND (29 unilateral and two bilateral) were included. There were 29 males and two females, with ages ranging from 36 to 76 years (median = 55 years) with one palate, one lateral wall, 17 tonsil, 11 base of tongue, and one vallecula primary tumor classified as follows: T1 (n = 9, 29%), T2 (n = 15, 48.4%), T3 (n = 7, 22.6%), N0 (n = 6, 19.4%), N1 (n = 15, 48.4%), N2b (n = 10, 32.3%), and N2c (n = 1, 3.2%). There were three stage I (9.7%), two stage II (6.5%), 15 stage III (48.4%) and 11 stage IVa (35.5%) patients. Twenty-two patients were treated postoperatively with adjuvant therapy (12 radiation alone and 12 combined radiation and chemotherapy). Primary outcome measured was regional recurrence rate. Results: There was one regional recurrence on the contralateral, non-operated neck and one distant recurrence among the 31 patients who underwent SND. Conclusions: SND after TORS resection of primary OPSCC enables the use of selective and deintensified adjuvant therapy to reduce regional recurrence rates. © 2010 The American Laryngological, Rhinological and Otological Society, Inc.