D’Ajello, F., K. Hoon Yub, et al. (2012). “Robotic thyroid surgery using bilateral axillo-breast approach: personal initial experience over two years.” Minerva Chirurgica 67(1): 39-48.
AIM: Although endoscopic thyroid surgery is gaining wide acceptance, however, manual endoscopic operation also has shown several limitations. The advent of robotic surgical systems, such as the da Vinci surgical system (Intuitive Surgical, Mountain View, CA, USA), is expected to make it possible to overcome some limitations of manual endoscopic operation. Herein we report a single surgeon (H.Y.K.)’s initial two-year experience of new robotic thyroid operations using the bilateral axillo-breast approach (BABA), the approach which has definite advantages and recently has been widely used for the traditional endoscopic thyroid surgery. METHODS: Between July 2008 and July 2010, 93 patients underwent robotic thyroid surgery using the BABA, with the da Vinci-S surgical system, at the Korea University Anam Hospital, Seoul, Korea. The data on the patients’ clinicopathological characteristics, operation types, operation times, surgical results, postoperative hospital stays and complications were collected in a prospective manner, and later evaluated. RESULTS: Seventy-two total thyroidectomies with or without central neck dissections mostly for the papillary carcinomas, twenty lobectomies with or without central neck dissections for the minute smaller than 0.5 cm in their maximal diameter papillary carcinomas, follicular neoplasms and benign tumors, and a bilateral subtotal lobectomy for the multinodular goiter were performed robotically. There was no conversion of robotic procedure to traditional endoscopic or open procedure. The mean total operation time was 288.5+/-48.0 minutes. The mean number of retrieved lymph nodes by the central neck dissection was 5.1+/-1.97 (range, 0-12). The mean hospital stay of the patients was 2.8+/-1.2 days. And the mean postoperative 3rd month serum thyroglobulin level in patients undergone total thyroidectomy was 0.3+/-0.14 ng/mL (range, 0.08-1.95). Three (3.2%) patients suffered from transient hoarseness postoperatively, but all of them recovered in three months. Transient hypocalcemias were observed in 17 out of 72 (23.6%) patients who had undergone total thyroidectomy, but none of them left permanent. No other complication, such as bleeding, infection, neither fluid collection, was observed. CONCLUSION: Our initial surgical results of robotic thyroid surgery using BABA demonstrate the feasibility and safety of the procedure in the treatment of benign tumors and early differentiated carcinomas.
Genden, E. M. and J. A. Aguirre-Ghiso (2012). “Oropharyngeal cancer biology and treatment: Insights from messenger RNA sequence analysis and transoral robotic surgery.” Mayo Clinic Proceedings87(3): 211-212.
Kandil, E. H., S. I. Noureldine, et al. (2012). “Robotic Transaxillary Thyroidectomy: An Examination of the First One Hundred Cases.” Journal of the American College of Surgeons.
Background: The influence of minimally invasive options has led to the application of new evolving techniques in thyroid surgery to eliminate visible neck scars. Here, we describe one author’s experience with transaxillary robotic thyroidectomy and examine the effect of experience on determining the learning curve and improvements over time in operative performance. Study Design: With IRB approval, a prospective analysis of our surgical experience was performed. All patients underwent robotic transaxillary thyroidectomy by a single surgeon between September 2009 and June 2011. Principal outcomes measures included length of hospital stay, incidence of complications, and effect of obesity on outcomes. Results: One hundred consecutive operations were performed on 91 patients. Sixty-nine hemithyroidectomy, 22 total or near-total thyroidectomy, and 9 completion thyroidectomy procedures were performed. Of patients who underwent hemithyroidectomy, 21.7% were discharged within 4 hours; the remaining patients were discharged within 23 hours. Mean operative time for hemithyroidectomy was 108.1 ± 60.5 minutes, and for total or near-total thyroidectomy, mean operative time was 118.1 ± 51.3 minutes. Mean robot docking time was 9.1 ± 2.2 minutes for all cases. Obesity contributed to prolonged total operative time. Improvement in the length of time to perform components of the procedure was noted after 45 cases. Two cases required conversion to a cervical approach. There were no instances of permanent vocal cord palsy on postoperative laryngoscopy. Conclusions: Here we report the largest experience of robotic gasless thyroid surgery in the United States. This novel technique provides excellent cosmetic results and can be performed as an outpatient procedure in selected group of patients. It is feasible and safe, however, has a lengthy learning curve. © 2012 American College of Surgeons.
Longfield, E. A., F. C. Holsinger, et al. (2012). “Reconstruction after Robotic Head and Neck Surgery: When and Why.” Journal of Reconstructive Microsurgery.
The advancement of robotically assisted surgery during the last decade has seen a revolution in the approach to surgical oncologic resection, moving toward reducing patient morbidity without compromising oncologic outcomes. In no field has this been more dramatic than in the application of transoral robotic surgery (TORS), using the da Vinci surgical system for resecting tumors of the head and neck. This organ-preserving technique allows the surgeon to remove tumors of the upper aerodigestive tract without external incisions and potentially spare the patient adjuvant treatment. The introduction of TORS improves upon current transoral techniques to the oropharynx and supraglottis. The traditional conception of TORS is that it would be used for smaller tumors and defects would be permitted to heal by secondary intention; however, as head and neck surgeons pursue larger tumors robotically, robotic-assisted reconstruction has entered the paradigm. Given the relative infancy of these procedures, clear guidelines for when reconstruction is warranted do not exist. The current literature, thus far, has focused on feasibility, safety, and implement of the robot in reconstruction. We reviewed the current literature pertinent to TORS reconstruction focusing on patient selection, tumor size, and location. Furthermore, we briefly review our own experience of 20 TORS procedures involving robotic-assisted reconstructions. Finally, we provide an algorithmic approach to determining the need for reconstruction in a given patient. This focuses on four key criteria: tumor location, tumor extent, prior treatment, and patient-specific factors.
Massasati, S., S. Noureldine, et al. (2012). “Robotic Transaxillary Thyroid Lobectomy of a Follicular Neoplasm.” Annals of Surgical Oncology: 1.
Purpose: Minimally invasive thyroid surgery using various techniques is well described. The purpose of this video is to show a robotic-assisted transaxillary right thyroid lobectomy for a follicular neoplasm with intraoperative nerve monitoring and stimulation of recurrent laryngeal nerve. Herein, we show our experience with the technique and its safety and feasibility. Methods: We performed a right thyroid lobectomy on a 33-year-old patient using the da Vinci-Si-HD Surgical System. The operation was done via a single axillary incision, 5 cm in length. The flap creation time was approximately 26 min. The robot docking time was 6 min. The recurrent laryngeal nerve was identified and nerve stimulation was used to stimulate with 0.5 milliamps. The operative console time was 21 min. Total operative time was 69 min. Results: The procedure was successfully completed. Blood loss was minimal. Postoperative laryngoscopy showed intact and mobile bilateral vocal cords. There were no complications. Patient was discharged 4 h after surgery. Conclusions: Robotic transaxillary endoscopic gasless thyroid surgery with monitoring and stimulation of the RLN is feasible and safe. This technique eliminates a visible neck scar and affords excellent high definition optics of the cervical anatomy. This new technique can be accomplished on an outpatient basis. © 2012 Society of Surgical Oncology.
Moore, E. J., S. M. Olsen, et al. (2012). “Long-term Functional and Oncologic Results of Transoral Robotic Surgery for Oropharyngeal Squamous Cell Carcinoma.” Mayo Clinic Proceedings 87(3): 219-225.
OBJECTIVE: To examine the long-term functional and oncologic results in patients who underwent transoral robotic surgery (TORS) as primary therapy or as part of combined therapy for oropharyngeal squamous cell carcinoma arising in the tonsil or base of tongue. PATIENTS AND METHODS: We reviewed a prospective TORS database of patients with squamous cell carcinoma arising in the tonsil or base of tongue treated between March 2007 and February 2009 to determine oncologic outcomes at 24 months or more of follow-up. The presenting tumor stage, histopathologic factors, surgical margins, and adjuvant treatment extent were evaluated. Functional outcomes included gastrostomy tube dependence and tracheostomy dependence. Oncologic outcomes included local, regional, and distant control and disease-specific and recurrence-free survival. RESULTS: A total of 66 TORS patients were followed up for a minimum of 2 years. Most (97.0%; 64 of 66) were able to eat orally within 3 weeks after surgery before starting adjuvant therapy. Long-term gastrostomy tube use was required in 3 of the 66 (4.5%) and long-term tracheotomy in 1 (1.5%). Three-year estimated local control and regional control were 97.0% and 94.0%, respectively. Two-year disease-specific survival and recurrence-free survival were 95.1% and 92.4%, respectively. CONCLUSION: With appropriate adjuvant therapy, TORS achieves excellent functional results for patients with oropharyngeal squamous cell carcinoma. Oncologic outcomes are equivalent or superior to results of other surgical and nonsurgical treatments.
Moore, E. J. and D. L. Price (2011). “Robotic surgery for head and neck cancer.” Minnesota Medicine94(11): 37-41.
During the last decade, robotic surgery has evolved from a novelty to the preferred surgical method for urologic, gynecologic, thoracic, cardiothoracic, and gastrointestinal procedures. The use of robotics in head and neck surgery grew out of the success of other transoral surgical modalities used to remove head and neck tumors. This article reviews the evolution of head and neck surgery, the current capabilities of surgical robots, and anticipated future applications of this technology.
Robinson, S., S. Krishnan, et al. (2012). “Robot-assisted, volumetric tongue base reduction and pharyngeal surgery for obstructive sleep apnea.” Operative Techniques in Otolaryngology – Head and Neck Surgery 23(1): 48-55.
A structured approach to Surgery for OSA has been clearly defined and accepted by the American Academy of Sleep Medicine. The aim of surgery is to address the collapsibility of structures of the upper airway.The da Vinci Robot (Intuitive Surgical, Sunnyvale, California, USA) has been validated and now approved by the Food and Drug Administration as an adjunct to transoral surgery. Trans Oral Robotic Surgery (TORS) has been proved to be useful in resection of oropharyngeal malignancy and some benign tumours of the parapharyngeal space. This is due to the excellent visual and instrument access, as well as the loss of tremor.The application of TORS for a variety of surgical procedures for sleep apnea is described. © 2012.
Terris, D. J. and M. C. Singer (2012). “Qualitative and Quantitative Differences between 2 Robotic Thyroidectomy Techniques.” Otolaryngology and Head and Neck Surgery.
Objectives. Two distinct remote access robotic thyroidectomy techniques were implemented in a high-volume endocrine surgery practice. Important technical and clinical differences were observed and are described.Study Design. Cross-sectional study with planned data collection.Setting. Thyroid center.Subjects and Methods. A panel of demographic and clinical parameters was captured in a series of patients undergoing 1 of 2 robotic thyroidectomy techniques (robotic axillary thyroidectomy [RAT] or robotic facelift thyroidectomy [RFT]). Particular attention was paid to time of surgery, ease of dissection, complications, use of drains, and length of stay.Results. Fifteen robotic hemithyroidectomies were accomplished by either RAT (n = 5) or RFT (n = 10). The duration of surgery for RAT averaged 196 +/- 38.1 minutes, with no clear downward trend observed. The mean time of surgery for RFT was 156.9 +/- 16.3 minutes, with a steady trend toward shorter surgical times. All 5 RAT patients were managed with drains and as inpatients (length of stay = 1.0 days); 9 of 10 RFT patients were managed without drains and on an outpatient basis (the first patient had a drain and was observed for 1 night in the hospital; P < .001). Ease of surgery, familiarity with anatomic dissection planes, and surgeon comfort level all favored RFT.Conclusions. In an early experience of a small series of patients, a more rapid learning curve reflected by shorter operative times was observed with robotic facelift thyroidectomy compared with robotic axillary thyroidectomy. Furthermore, the vast majority of patients could be managed as outpatients, which represents one of several apparent advantages.
Terris, D. J. and M. C. Singer (2012). “Robotic facelift thyroidectomy: Facilitating remote access surgery.” Head and Neck.
BACKGROUND: A novel remote access robotic thyroidectomy technique has been described that uses as its portal a postauricular and occipital hairline (facelift) incision. Experimental investigation and clinical validation have been completed. A detailed technical description is provided. METHODS AND MATERIALS: A young woman with a thyroid nodule was referred for surgery. Because of her concerns about a visible neck scar, she opted for remote access thyroidectomy. RESULTS: A left robotic facelift thyroidectomy was performed in less than 2 hours as a drainless, outpatient procedure. Videographic demonstration of the robotic resection is included. CONCLUSIONS: A number of remote access thyroidectomy techniques have proliferated. We developed and described an intuitive approach that uses familiar dissection planes and avoids the need for breast incisions and crossing the clavicle. (c) 2012 Wiley Periodicals, Inc. Head Neck, 2012.
Van Abel, K. M. and E. J. Moore (2012). “The rise of transoral robotic surgery in the head and neck: Emerging applications.” Expert Review of Anticancer Therapy 12(3): 373-380.
The use of robotics in the field of head and neck surgery has provided surgeons with the ability to access anatomic locations that were previously only managed via open techniques. This has resulted in decreased overall morbidity, excellent functional results and the promise of equivalent oncologic outcomes. Transoral robotic surgery (TORS) provides access to the oropharynx, hypopharynx, larynx, oral cavity, parapharyngeal space and skull base vial the oral aperture. Studies reviewing the application of TORS to these subsites have been promising, and for many applications TORS has been accepted as a safe and efficacious option for surgical management. However, despite these promising results, TORS remains a surgical instrument that requires sound surgical skill, clinical judgment and oncologic principles, and should be chosen based on the needs of the individual patient and the comfort of the treating surgeon. In this article, we review the history of TORS, relevant anatomy and provide a review of the literature, highlighting the applications, advantages, functional outcomes and disadvantages of TORS for each anatomic subsite. © 2012 Expert Reviews Ltd.
Vicini, C., F. Montevecchi, et al. (2012). “Transoral robotic surgery: Tongue base reduction and supraglottoplasty for obstructive sleep apnea.” Operative Techniques in Otolaryngology – Head and Neck Surgery 23(1): 45-47.
A transoral robotic version of Chabolle’s tongue base reduction with hyoid epiglottoplasty for obstructive sleep apnea syndrome is described. The main tongue base and supraglottic surgical steps are pointed out, as well as the indications and potential complications. The advantages and limits of this minimally invasive approach are discussed. © 2012 Elsevier Inc.
Terris, D. J. and M. C. Singer (2012). “Qualitative and Quantitative Differences between 2 Robotic Thyroidectomy Techniques.” Otolaryngology and Head and Neck Surgery.
Objectives. Two distinct remote access robotic thyroidectomy techniques were implemented in a high-volume endocrine surgery practice. Important technical and clinical differences were observed and are described.Study Design. Cross-sectional study with planned data collection.Setting. Thyroid center.Subjects and Methods. A panel of demographic and clinical parameters was captured in a series of patients undergoing 1 of 2 robotic thyroidectomy techniques (robotic axillary thyroidectomy [RAT] or robotic facelift thyroidectomy [RFT]). Particular attention was paid to time of surgery, ease of dissection, complications, use of drains, and length of stay.Results. Fifteen robotic hemithyroidectomies were accomplished by either RAT (n = 5) or RFT (n = 10). The duration of surgery for RAT averaged 196 +/- 38.1 minutes, with no clear downward trend observed. The mean time of surgery for RFT was 156.9 +/- 16.3 minutes, with a steady trend toward shorter surgical times. All 5 RAT patients were managed with drains and as inpatients (length of stay = 1.0 days); 9 of 10 RFT patients were managed without drains and on an outpatient basis (the first patient had a drain and was observed for 1 night in the hospital; P < .001). Ease of surgery, familiarity with anatomic dissection planes, and surgeon comfort level all favored RFT.Conclusions. In an early experience of a small series of patients, a more rapid learning curve reflected by shorter operative times was observed with robotic facelift thyroidectomy compared with robotic axillary thyroidectomy. Furthermore, the vast majority of patients could be managed as outpatients, which represents one of several apparent advantages.