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Hunter CJ, Romaniw NN, Beckham R, Farsi S, Benefield A, Solverson M, Gray EA, Nguyen E, Marshall A, King D, Sunde J, Moreno M, Vural E. Utility of video fluoroscopic swallow study in advancing oral diet post TORS for oropharyngeal malignancies. Am J Otolaryngol 2024; 45:104336. [PMID: 38704947 DOI: 10.1016/j.amjoto.2024.104336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 04/21/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVE TORS is a minimally invasive surgical alternative to chemoradiotherapy for oropharyngeal malignancies. While early postoperative oropharyngeal dysphagia is linked to TORS, this study explores both subjective and objective swallowing outcomes. STUDY DESIGN Retrospective and prospective review of the patients who underwent TORS for oropharyngeal malignancy from 2018 to 2023. SETTING Single tertiary referral center. METHODS Postoperative transnasal feeding tubes were administered to 142 patients undergoing TORS. Data on oncological, clinical, surgical, and pathological parameters, including VFSS records, pain with swallow, and feeding tube removal timing, were collected. Clinical swallow exam (CSE) was conducted on POD-1, with a formal swallow study pursued if inconclusive. Once a safe swallow was confirmed, oral diets were initiated, and the feeding tube removed, with most patients discharged on POD-2. RESULTS At an average age of 59.3 years on the day of operation, the palatine tonsil (N = 101) was the predominant subsite. A dobhoff feeding tube was intraoperatively placed in 98 % of patients (N = 139). On POD-1, CSE was conducted in 119 patients, with 26 % (37/119) cleared for total oral diet (NOMS ≥ 4). Additionally, 30 out of 73 VFSS patients were cleared for total oral diet. A total of 54.9 % (78/142) had the feeding tube removed before discharge on POD-2, with a mean time of 6.5 ± 6.6 days. Overall, 71.1 % (101/142) achieved a total oral diet within one week after TORS. CONCLUSION Early post-TORS swallowing is vital for oropharyngeal malignancies. VFSS assesses post-operative swallowing safety, allowing most patients to resume total oral nutrition shortly after TORS.
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Affiliation(s)
- Courtney J Hunter
- University of Arkansas for Medical Sciences, Department of Otolaryngology - Head and Neck Surgery, Little Rock, AR, United States
| | - Natalie N Romaniw
- University of Arkansas for Medical Sciences, Department of Otolaryngology - Head and Neck Surgery, Little Rock, AR, United States
| | - Rachel Beckham
- University of Arkansas for Medical Sciences, Department of Otolaryngology - Head and Neck Surgery, Little Rock, AR, United States
| | - Soroush Farsi
- University of Arkansas for Medical Sciences, Department of Otolaryngology - Head and Neck Surgery, Little Rock, AR, United States
| | - Anna Benefield
- University of Arkansas for Medical Sciences, Department of Otolaryngology - Head and Neck Surgery, Little Rock, AR, United States
| | - Matthew Solverson
- University of Arkansas for Medical Sciences, Department of Otolaryngology - Head and Neck Surgery, Little Rock, AR, United States
| | - Emily A Gray
- University of Arkansas for Medical Sciences, Department of Otolaryngology - Head and Neck Surgery, Little Rock, AR, United States
| | - Emma Nguyen
- University of Arkansas for Medical Sciences, Department of Otolaryngology - Head and Neck Surgery, Little Rock, AR, United States
| | - Aubrey Marshall
- University of Arkansas for Medical Sciences, Department of Otolaryngology - Head and Neck Surgery, Little Rock, AR, United States
| | - Deanne King
- University of Arkansas for Medical Sciences, Department of Otolaryngology - Head and Neck Surgery, Little Rock, AR, United States
| | - Jumin Sunde
- University of Arkansas for Medical Sciences, Department of Otolaryngology - Head and Neck Surgery, Little Rock, AR, United States
| | - Mauricio Moreno
- University of Arkansas for Medical Sciences, Department of Otolaryngology - Head and Neck Surgery, Little Rock, AR, United States
| | - Emre Vural
- University of Arkansas for Medical Sciences, Department of Otolaryngology - Head and Neck Surgery, Little Rock, AR, United States.
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Caporale CD, Chiari F, D’Alessio P, Barbara F, Guarino P. Transoral robotic surgery for supraglottic cancer. A review of oncological and functional outcomes compared to open surgery. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2024; 44:S20-S27. [PMID: 38745513 PMCID: PMC11098539 DOI: 10.14639/0392-100x-suppl.1-44-2024-n2919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 01/31/2024] [Indexed: 05/16/2024]
Abstract
Objective Supraglottic squamous cell carcinoma (SCC) represents a major surgical challenge in organ-preserving treatment. Type I open partial horizontal laryngectomy (OPHL I) is considered the most popular. To date, minimally-invasive approaches such as laser microsurgery and transoral robotic surgery (TORS) have gained increasing relevance. The aim of this narrative review is to obtain a descriptive comparison of functional and oncological outcomes from studies on patients with supraglottic SCC treated with OPHL I and TORS, respectively. Material and methods A computerised search was performed using the Pubmed database for articles published from 2000 to 2023. A comparative analysis on functional and oncological outcomes of patients treated by TORS and OPHL I was performed. Results The present narrative review shows a superiority of TORS compared to open surgery for supraglottic SCC in terms of functional outcomes, while maintaining comparable oncological outcomes. Conclusions Although recently introduced in the treatment of laryngeal pathology, TORS has been shown to be a reliable technique not only for functional but also for oncological outcomes, ensuring good overall survival, disease-free survival, and disease control rates comparable to OPHL I.
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Affiliation(s)
| | - Francesco Chiari
- Otorhinolaryngology and Audiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Pasquale D’Alessio
- Otorhinolaryngology and Head and Neck Unit, “Santo Spirito” Hospital, Pescara, Italy
| | - Francesco Barbara
- Otorhinolaryngology and Head and Neck Unit, Policlinico of Bari, Bari, Italy
| | - Pierre Guarino
- Otorhinolaryngology and Head and Neck Unit, “Santo Spirito” Hospital, Pescara, Italy
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3
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Singh S, Singh BK, Kumar A. Multi-organ segmentation of organ-at-risk (OAR's) of head and neck site using ensemble learning technique. Radiography (Lond) 2024; 30:673-680. [PMID: 38364707 DOI: 10.1016/j.radi.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 11/25/2023] [Accepted: 02/05/2024] [Indexed: 02/18/2024]
Abstract
INTRODUCTION This paper presents a novel approach to automate the segmentation of Organ-at-Risk (OAR) in Head and Neck cancer patients using Deep Learning models combined with Ensemble Learning techniques. The study aims to improve the accuracy and efficiency of OAR segmentation, essential for radiotherapy treatment planning. METHODS The dataset comprised computed tomography (CT) scans of 182 patients in DICOM format, obtained from an institutional image bank. Experienced Radiation Oncologists manually segmented seven OARs for each scan. Two models, 3D U-Net and 3D DenseNet-FCN, were trained on reduced CT scans (192 × 192 x 128) due to memory limitations. Ensemble Learning techniques were employed to enhance accuracy and segmentation metrics. Testing was conducted on 78 patients from the institutional dataset and an open-source dataset (TCGA-HNSC and Head-Neck Cetuximab) consisting of 31 patient scans. RESULTS Using the Ensemble Learning technique, the average dice similarity coefficient for OARs ranged from 0.990 to 0.994, indicating high segmentation accuracy. The 95% Hausdorff distance (mm) ranged from 1.3 to 2.1, demonstrating precise segmentation boundaries. CONCLUSION The proposed automated segmentation method achieved efficient and accurate OAR segmentation, surpassing human expert performance in terms of time and accuracy. IMPLICATIONS FOR PRACTICE This approach has implications for improving treatment planning and patient care in radiotherapy. By reducing manual segmentation reliance, the proposed method offers significant time savings and potential improvements in treatment planning efficiency and precision for head and neck cancer patients.
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Affiliation(s)
- S Singh
- Department of Physics, GLA University, Mathura, Uttar Pradesh, India; Department of Radiation Oncology, Division of Medical Physics, Rajiv Gandhi Cancer Institute and Research Center, New Delhi, India.
| | - B K Singh
- Department of Physics, GLA University, Mathura, Uttar Pradesh, India.
| | - A Kumar
- Department of Radiotherapy, S N. Medical College, Agra, Uttar Pradesh, India.
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4
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Anaesthesia for transoral robotic surgery. BJA Educ 2022; 22:118-123. [PMID: 35211329 PMCID: PMC8847838 DOI: 10.1016/j.bjae.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2021] [Indexed: 11/22/2022] Open
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5
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Gaino F, Gorphe P, Vander Poorten V, Holsinger FC, Lira RB, Duvvuri U, Garrel R, Van Der Vorst S, Cristalli G, Ferreli F, De Virgilio A, Giannitto C, Morenghi E, Colombo G, Malvezzi L, Spriano G, Mercante G. Preoperative predictors of difficult oropharyngeal exposure for transoral robotic surgery: The Pharyngoscore. Head Neck 2021; 43:3010-3021. [PMID: 34132440 DOI: 10.1002/hed.26792] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/28/2021] [Accepted: 06/09/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Insufficient exposure may require termination of procedure in transoral robotic surgery (TORS). The aim of study was to develop a "Pharyngoscore" to quantify the risk of difficult oropharyngeal exposure (DOE) before TORS. METHODS Three-hundred six patients undergoing any surgical procedure at one Academic Hospital were prospectively enrolled. Oropharynx was exposed with Feyh-Kastenbauer retractor. Exposure was evaluated by direct and endoscopic visualization of the four oropharyngeal subsites. Preoperative clinical/anthropometric parameters were studied in good oropharyngeal exposure and DOE groups. Logistic regression was performed to explore association between clinical/anthropometric parameters and DOE. Statistically significant parameters at multivariate analysis were incorporated into a nomogram. RESULTS Sixty-five (21.2%) subjects were characterized by DOE. Variables associated with DOE at univariate analysis were male (p = 0.031), modified Mallampati Class (MMC) ≥ III (p < 0.001), smaller interincisor gap (p < 0.001), and larger neck circumference (p = 0.006). MMC, interincisor gap, and neck circumference were significant at multivariate analysis and were presented with a nomogram for creating the Pharyngoscore. CONCLUSIONS The Pharyngoscore is a promising tool for calculating DOE probability before TORS.
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Affiliation(s)
- Francesca Gaino
- Humanitas University, Department of Biomedical Sciences, Milan, Italy.,Otorhinolaryngology - Head & Neck Surgery Unit, Humanitas Research Hospital - IRCCS, Milan, Italy
| | - Philippe Gorphe
- Department of Head and Neck Oncology, Institute Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Vincent Vander Poorten
- Otorhinolaryngology-Head and Neck Surgery, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium.,Department of Oncology - Section Head and Neck Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - F Christopher Holsinger
- Division of Head and Neck Surgery, School of Medicine, Stanford University, Palo Alto, California, USA
| | - Renan B Lira
- Department of Head and Neck Surgery, AC Camargo Cancer Center, São Paulo, Brazil; Robotic Surgery Program, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Umamaheswar Duvvuri
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Renaud Garrel
- Département ORL CCF et CMF, CHU de Montpellier, Montpellier, France
| | - Sebastien Van Der Vorst
- Department of Head and Neck Surgery, Université catholique de Louvain, CHU UCL Namur-site Godinne, Yvoir, Belgium
| | - Giovanni Cristalli
- Otorhinolaryngology Unit, Ospedali Riuniti Padova Sud "Madre Teresa Di Calcutta", Padua, Italy
| | - Fabio Ferreli
- Humanitas University, Department of Biomedical Sciences, Milan, Italy.,Otorhinolaryngology - Head & Neck Surgery Unit, Humanitas Research Hospital - IRCCS, Milan, Italy
| | - Armando De Virgilio
- Humanitas University, Department of Biomedical Sciences, Milan, Italy.,Otorhinolaryngology - Head & Neck Surgery Unit, Humanitas Research Hospital - IRCCS, Milan, Italy
| | - Caterina Giannitto
- Diagnostic Radiology Unit, Humanitas Clinical and Research Center - IRCCS, Milan, Italy
| | - Emanuela Morenghi
- Biostatistics Unit, Humanitas Clinical and Research Center - IRCCS, Milan, Italy
| | - Giovanni Colombo
- Humanitas University, Department of Biomedical Sciences, Milan, Italy.,Otorhinolaryngology - Head & Neck Surgery Unit, Humanitas Research Hospital - IRCCS, Milan, Italy
| | - Luca Malvezzi
- Humanitas University, Department of Biomedical Sciences, Milan, Italy.,Otorhinolaryngology - Head & Neck Surgery Unit, Humanitas Research Hospital - IRCCS, Milan, Italy
| | - Giuseppe Spriano
- Humanitas University, Department of Biomedical Sciences, Milan, Italy.,Otorhinolaryngology - Head & Neck Surgery Unit, Humanitas Research Hospital - IRCCS, Milan, Italy
| | - Giuseppe Mercante
- Humanitas University, Department of Biomedical Sciences, Milan, Italy.,Otorhinolaryngology - Head & Neck Surgery Unit, Humanitas Research Hospital - IRCCS, Milan, Italy
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Thariat J, Leleu T, Micault E, Gery B, Bastit V, Jeanne C, Humbert M, Dugas A, Le Guevelou J, Florescu C, Patron V, Lasne-Cardon A, Babin E. Dix ans de progrès en chirurgie des tumeurs de la tête et du cou, quel impact sur la radiothérapie postopératoire ? Bull Cancer 2020; 107:823-829. [DOI: 10.1016/j.bulcan.2020.04.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 04/15/2020] [Accepted: 04/17/2020] [Indexed: 11/30/2022]
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7
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The French world premiere of transoral robotic surgery for pituitary tumors with the Da Vinci apparatus: Promises and pitfalls. Neurochirurgie 2020; 66:282-283. [PMID: 32413371 DOI: 10.1016/j.neuchi.2020.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 01/27/2020] [Accepted: 02/22/2020] [Indexed: 11/22/2022]
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8
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Gangwani K, Shetty L, Seshagiri R, Kulkarni D. Comparison of TORS with Conventional Surgery for Oropharyngeal Carcinomas in T1-T4 Lesions. Ann Maxillofac Surg 2019; 9:387-392. [PMID: 31909020 PMCID: PMC6933975 DOI: 10.4103/ams.ams_33_18] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objectives: Transoral Robotic Simulation (TORS) is an innovative surgical technique indicated for resection of selected head-and-neck cancers. The authors conducted a systematic review discussing the indications, advantages, and disadvantages of this technique. Data Sources: The search included MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, COCHRANE, and bibliographies of relevant studies through January 2006. Materials and Methods: Studies included patients treated for T1–T4 stage oropharynx cancer with TORS. Study retrieval and data extraction were conducted in duplicate and resolved by consensus. Treatment specific details, as well as recurrence, survival, and adverse events, were collected. Methodological quality for each study was appraised. Results: Nine studies were included which met the inclusion criteria. Patients receiving TORS required adjuvant radiotherapy (26%) or chemoradiotherapy (41%). Two-year overall survival estimates ranged from 82% to 94% for TORS. Conclusion: The minimally invasive transoral robotic simulation (TORS) for the treatment of oropharyngeal cancers is proved to be less time-consuming, compliant to the patients, and having less complications as compared to the more invasive techniques involving conventional surgery although the quality of this evidence is limited.
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Affiliation(s)
- Khushal Gangwani
- Department of Oral and Maxillofacial Surgery, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India
| | - Lakshmi Shetty
- Department of Oral and Maxillofacial Surgery, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India
| | - Ratnadeepika Seshagiri
- Department of Oral and Maxillofacial Surgery, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India
| | - Deepak Kulkarni
- Department of Oral and Maxillofacial Surgery, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India
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9
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Gorphe P. A Contemporary Review of Evidence for Transoral Robotic Surgery in Laryngeal Cancer. Front Oncol 2018; 8:121. [PMID: 29721446 PMCID: PMC5915483 DOI: 10.3389/fonc.2018.00121] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 04/04/2018] [Indexed: 12/03/2022] Open
Abstract
Numerous studies have shown that transoral robotic surgery (TORS) for oropharyngeal cancers is safe and that it yields satisfactory functional and oncological outcomes. For many teams worldwide, it is therefore a standard surgical approach with eligible patients. In the same time, TORS is increasingly being used and described in the context of laryngeal cancer surgery. It is proposed as an alternative to open approaches, which may yield inconsistent functional results and significant rates of postoperative complications. It may also be an alternative to definitive radiotherapy, which entails significant early and late toxicities. Moreover, it has been explored as an alternative to endoscopic laser surgery in patients with difficult exposure, even though there is still a lack of evidence about which procedure provides better vizualization of the vocal cords. This article provides a review of the indications for TORS in laryngeal cancer, the peri-operative morbidity, functional outcomes, and oncological results.
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Affiliation(s)
- Philippe Gorphe
- Department of Head and Neck Oncology, Institute Gustave Roussy, Université Paris-Saclay, Villejuif, France
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10
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Gorphe P, Auperin A, Honart JF, Ton Van J, El Bedoui S, Bidault F, Temam S, Kolb F, Qassemyar Q. Revisiting vascular contraindications for transoral robotic surgery for oropharyngeal cancer. Laryngoscope Investig Otolaryngol 2018; 3:121-126. [PMID: 29721545 PMCID: PMC5915826 DOI: 10.1002/lio2.152] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 02/05/2018] [Accepted: 03/01/2018] [Indexed: 12/25/2022] Open
Abstract
Objective We analyzed the outcomes for patients with a retropharyngeal internal carotid artery (ICA) who underwent a transoral robotic surgery (TORS) procedure involving a cervical‐transoral robotic oropharyngectomy course with free flap reconstruction. Methods Patients were included in the prospective multicentric trial NCT02517125. These patients were scheduled to undergo surgery for an oropharyngeal localization. By pre‐operative CT scan and MRI it was determined that they had a retropharyngeal internal carotid artery. Results Three patients had a retropharyngeal ICA: a patient with a 35 mm synovial sarcoma of the tonsillar fossa, a patient with a T2N2b squamous‐cell carcinoma (SCC) of the glossotonsillar sulcus, and a patient with a T3N0 SCC of the tonsillar fossa in a previously irradiated field. These patients encountered neither preoperative nor postoperative complications. Conclusions In our experience, TORS for oropharyngeal cancers appears to be feasible in patients with a retropharyngeal ICA, provided that the procedure has been adapted for complex situations. Level of evidence 4.
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Affiliation(s)
- Philippe Gorphe
- Department of Head and Neck Oncology Gustave Roussy, Université Paris-Saclay, Villejuif, France; and the Department of Head and Neck Oncology, Oscar Lambret Lille France
| | - Anne Auperin
- Department of Statistics Gustave Roussy, Université Paris-Saclay, Villejuif, France; and the Department of Head and Neck Oncology, Oscar Lambret Lille France
| | - Jean-François Honart
- Department of Plastic and Reconstructive Surgery Gustave Roussy, Université Paris-Saclay, Villejuif, France; and the Department of Head and Neck Oncology, Oscar Lambret Lille France
| | - Jean Ton Van
- Department of Head and Neck Oncology Gustave Roussy, Université Paris-Saclay, Villejuif, France; and the Department of Head and Neck Oncology, Oscar Lambret Lille France.,Department of Statistics Gustave Roussy, Université Paris-Saclay, Villejuif, France; and the Department of Head and Neck Oncology, Oscar Lambret Lille France.,Department of Plastic and Reconstructive Surgery Gustave Roussy, Université Paris-Saclay, Villejuif, France; and the Department of Head and Neck Oncology, Oscar Lambret Lille France.,Department of Radiology Gustave Roussy, Université Paris-Saclay, Villejuif, France; and the Department of Head and Neck Oncology, Oscar Lambret Lille France
| | - Sophie El Bedoui
- Department of Head and Neck Oncology Gustave Roussy, Université Paris-Saclay, Villejuif, France; and the Department of Head and Neck Oncology, Oscar Lambret Lille France.,Department of Statistics Gustave Roussy, Université Paris-Saclay, Villejuif, France; and the Department of Head and Neck Oncology, Oscar Lambret Lille France.,Department of Plastic and Reconstructive Surgery Gustave Roussy, Université Paris-Saclay, Villejuif, France; and the Department of Head and Neck Oncology, Oscar Lambret Lille France.,Department of Radiology Gustave Roussy, Université Paris-Saclay, Villejuif, France; and the Department of Head and Neck Oncology, Oscar Lambret Lille France
| | - François Bidault
- Department of Radiology Gustave Roussy, Université Paris-Saclay, Villejuif, France; and the Department of Head and Neck Oncology, Oscar Lambret Lille France
| | - Stéphane Temam
- Department of Head and Neck Oncology Gustave Roussy, Université Paris-Saclay, Villejuif, France; and the Department of Head and Neck Oncology, Oscar Lambret Lille France
| | - Frédéric Kolb
- Department of Plastic and Reconstructive Surgery Gustave Roussy, Université Paris-Saclay, Villejuif, France; and the Department of Head and Neck Oncology, Oscar Lambret Lille France
| | - Quentin Qassemyar
- Department of Plastic and Reconstructive Surgery Gustave Roussy, Université Paris-Saclay, Villejuif, France; and the Department of Head and Neck Oncology, Oscar Lambret Lille France
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11
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Nasopharynx access by minimally invasive transoral robotic surgery: anatomical study. J Robot Surg 2018; 12:687-692. [DOI: 10.1007/s11701-018-0804-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 03/12/2018] [Indexed: 10/17/2022]
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12
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Chauvet D, Hans S, Missistrano A, Rebours C, Bakkouri WE, Lot G. Transoral robotic surgery for sellar tumors: first clinical study. J Neurosurg 2017; 127:941-948. [DOI: 10.3171/2016.9.jns161638] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVEThe aim of this study was to confirm the feasibility of an innovative transoral robotic surgery (TORS), using the da Vinci Surgical System, for patients with sellar tumors. This technique was designed to offer a new minimally invasive approach, without soft-palate splitting, that avoids the rhinological side effects of classic endonasal approaches.METHODSThe authors performed a prospective study of TORS in patients with symptomatic sellar tumors. Specific anatomical features were required for inclusion in the study and were determined on the basis of preoperative open-mouth CT scans of the brain. The main outcome measure was sellar accessibility using the robot. Resection quality, mean operative time, postoperative changes in patients' vision, side effects, and complications were additionally reported.RESULTSBetween February and May 2016, 4 patients (all female, mean age 49.5 years) underwent TORS for resection of sellar tumors as participants in this study. All patients presented with symptomatic visual deficits confirmed as bitemporal hemianopsia. All tumors had a suprasellar portion and a cystic part. In all 4 cases, the operation was performed via TORS, without the need for a second surgery. Sella turcica accessibility was satisfactory in all cases. In 3 cases, tumor resection was complete. The mean operative time was 2 hours 43 minutes. Three patients had a significant visual improvement at Day 1. No rhinological side effects or complications in patients occurred. No pathological examination was performed regarding the fluid component of the tumors. There was 1 postoperative delayed CSF leak and 1 case of transient diabetes insipidus. Side effects specific to TORS included minor sore throat, transient hypernasal speech, and 1 case of delayed otitis media. The mean length of hospital stay and mean follow up were 8.25 days and 82 days, respectively.CONCLUSIONSTo our knowledge, this is the first report of the surgical treatment of sellar tumors by means of a minimally invasive TORS. This approach using the da Vinci Surgical System seems feasible and constitutes an innovative neurosurgical technique that may avoid the adverse side effects and technical disadvantages of the classic transsphenoidal route. Moreover, TORS allows an inferosuperior approach to the sella turcica, which is a key point, as the tumor is approached in the direction of its growth.
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Affiliation(s)
| | - Stéphane Hans
- 2Department of Head and Neck Surgery, Hôpital Européen Georges Pompidou, Paris, France; and
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13
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Liu HH, Li LJ, Shi B, Xu CW, Luo E. Robotic surgical systems in maxillofacial surgery: a review. Int J Oral Sci 2017; 9:63-73. [PMID: 28660906 PMCID: PMC5518975 DOI: 10.1038/ijos.2017.24] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2017] [Indexed: 12/26/2022] Open
Abstract
Throughout the twenty-first century, robotic surgery has been used in multiple oral surgical procedures for the treatment of head and neck tumors and non-malignant diseases. With the assistance of robotic surgical systems, maxillofacial surgery is performed with less blood loss, fewer complications, shorter hospitalization and better cosmetic results than standard open surgery. However, the application of robotic surgery techniques to the treatment of head and neck diseases remains in an experimental stage, and the long-lasting effects on surgical morbidity, oncologic control and quality of life are yet to be established. More well-designed studies are needed before this approach can be recommended as a standard treatment paradigm. Nonetheless, robotic surgical systems will inevitably be extended to maxillofacial surgery. This article reviews the current clinical applications of robotic surgery in the head and neck region and highlights the benefits and limitations of current robotic surgical systems.
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Affiliation(s)
- Hang-Hang Liu
- State Key Laboratory of Oral
Diseases, National Clinical Research Center for Oral Diseases, West China
Hospital of Stomatology, Sichuan University, Chengdu,
China
| | - Long-Jiang Li
- State Key Laboratory of Oral
Diseases, National Clinical Research Center for Oral Diseases, West China
Hospital of Stomatology, Sichuan University, Chengdu,
China
| | - Bin Shi
- State Key Laboratory of Oral
Diseases, National Clinical Research Center for Oral Diseases, West China
Hospital of Stomatology, Sichuan University, Chengdu,
China
| | - Chun-Wei Xu
- State Key Laboratory of Oral
Diseases, National Clinical Research Center for Oral Diseases, West China
Hospital of Stomatology, Sichuan University, Chengdu,
China
| | - En Luo
- State Key Laboratory of Oral
Diseases, National Clinical Research Center for Oral Diseases, West China
Hospital of Stomatology, Sichuan University, Chengdu,
China
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Gorphe P, Von Tan J, El Bedoui S, Hartl DM, Auperin A, Qassemyar Q, Moya-Plana A, Janot F, Julieron M, Temam S. Early assessment of feasibility and technical specificities of transoral robotic surgery using the da Vinci Xi. J Robot Surg 2017; 11:455-461. [PMID: 28064382 DOI: 10.1007/s11701-017-0679-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 01/02/2017] [Indexed: 11/26/2022]
Abstract
The latest generation Da Vinci® Xi™ Surgical System Robot released has not been evaluated to date in transoral surgery for head and neck cancers. We report here the 1-year results of a non-randomized phase II multicentric prospective trial aimed at assessing its feasibility and technical specificities. Our primary objective was to evaluate the feasibility of transoral robotic surgery using the da Vinci® Xi™ Surgical System Robot. The secondary objective was to assess peroperative outcomes. Twenty-seven patients, mean age 62.7 years, were included between May 2015 and June 2016 with tumors affecting the following sites: oropharynx (n = 21), larynx (n = 4), hypopharynx (n = 1), parapharyngeal space (n = 1). Eighteen patients were included for primary treatment, three for a local recurrence, and six for cancer in a previously irradiated field. Three were reconstructed with a FAMM flap and 6 with a free ALT flap. The mean docking time was 12 min. "Chopsticking" of surgical instruments was very rare. During hospitalization following surgery, 3 patients experienced significant bleeding between day 8 and 9 that required surgical transoral hemostasis (n = 1) or endovascular embolization (n = 2). Transoral robotic surgery using the da Vinci® Xi™ Surgical System Robot proved feasible with technological improvements compared to previous generation surgical system robots and with a similar postoperative course. Further technological progress is expected to be of significant benefit to the patients.
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Affiliation(s)
- Philippe Gorphe
- Department of Head and Neck Oncology, Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif, France.
| | - Jean Von Tan
- Department of Head and Neck Oncology, Oscar Lambret, Lille, France
| | - Sophie El Bedoui
- Department of Head and Neck Oncology, Oscar Lambret, Lille, France
| | - Dana M Hartl
- Department of Head and Neck Oncology, Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif, France
| | - Anne Auperin
- Department of Head and Neck Oncology, Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif, France
| | - Quentin Qassemyar
- Department of Head and Neck Oncology, Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif, France
| | - Antoine Moya-Plana
- Department of Head and Neck Oncology, Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif, France
| | - François Janot
- Department of Head and Neck Oncology, Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif, France
| | - Morbize Julieron
- Department of Head and Neck Oncology, Oscar Lambret, Lille, France
| | - Stephane Temam
- Department of Head and Neck Oncology, Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif, France
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Preliminary study of transoral robotic surgery for pharyngeal cancer in Japan. J Robot Surg 2015; 10:11-7. [PMID: 26645072 PMCID: PMC4766218 DOI: 10.1007/s11701-015-0547-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 11/22/2015] [Indexed: 11/02/2022]
Abstract
Transoral robotic surgery (TORS) with the da Vinci Surgical System has been used for the removal of pharyngeal and laryngeal cancers with the objective to improve functional and aesthetic outcomes without worsening survival. While TORS has been approved in many countries, Japan's FDA has not yet done so. Our hospital started using TORS with the approval of the Ethical Review Board and the Minimum Invasive Surgical Center Committee at Tottori University. No surgical outcomes of TORS for Japanese patients with head and neck cancer have been reported in Japan. This paper deals with the outcomes and feasibility of TORS for Japanese patients with pharyngeal cancer at our institution. TORS was performed for 10 patients with T1, T2, T3 oropharyngeal and hypopharyngeal squamous cell carcinoma between 2013 and 2014. This is a single-institutional study. TORS could be completed for all cases, except one patient that was not candidate, and no intraoperative conversion to an open surgical procedure was required. Five patients underwent neck dissection, two of them concurrent and three staged. Of all patients, positive surgical margins were detected in two. The average blood loss including neck dissection was 21.5 ± 33.4 ml, the operation time was 183 ± 36 min and the console time was 103 ± 22 min. No tracheostomy had been performed either pre- or postoperatively, and there was no difference between preoperative and postoperative swallowing functions. In this single-institutional preliminary study, we demonstrated that TORS is a feasible and safe treatment. A clinical multi-institutional study of TORS for laryngopharyngeal cancer has been approved as an advanced medical system study and is under way. In the near future, it is expected that the efficacy and safety of TORS for laryngopharyngeal cancer will be confirmed as the result of this multiple-institutional clinical study in Japan.
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Treatment strategies in early-stage oropharyngeal squamous cell carcinoma: a French national survey. Eur Arch Otorhinolaryngol 2015; 273:2201-7. [DOI: 10.1007/s00405-015-3744-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 07/31/2015] [Indexed: 10/23/2022]
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Affiliation(s)
- Jon Burton
- Department of Otolaryngology – Head & Neck Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Robert Wong
- Department of Otolaryngology – Head & Neck Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Tapan Padhya
- Department of Otolaryngology – Head & Neck Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida
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Anatomical features of skull base and oral cavity: a pilot study to determine the accessibility of the sella by transoral robotic-assisted surgery. Neurosurg Rev 2015; 38:723-30. [PMID: 25924605 DOI: 10.1007/s10143-015-0635-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Accepted: 01/19/2015] [Indexed: 10/23/2022]
Abstract
The role of transoral robotic surgery (TORS) in the skull base emerges and represents the natural progression toward miniinvasive resections in confined spaces. The accessibility of the sella via TORS has been recently described on fresh human cadavers. An anatomic study is mandatory to know if this approach would be feasible in the majority of patients regardless of their oral morphological features. From 30 skull base CT scans from patients who were asked to open their mouth as wide as they can, we measured specific dimensions of the oral cavity and the skull base, such as length of the palate, mouth opening and distance from the sella to the palate. All data were acquired on a sagittal midline plane and on a 25° rotation plane, which simulated the axis of the robotic instruments. Looking at the projection of the dental palatine line on the sella, we studied possible predictive factors of sellar accessibility and tried to bring objective data for surgical feasibility. We also proposed an angle α to study the working angle at the skull base. We observed that the maximal mouth opening was a good predictive factor of sellar accessibility by TORS (p < 0.05). The mouth aperture threshold value for a good sensitivity, over 80 %, was comparable to the mean value of mouth opening in our series, 38.9 and 39.4 mm respectively. Moreover, we showed a statistically significant increase of the working angle α at the skull base comparing the lateral access to the midline one (p < 0.05). This seemed to quantitatively demonstrate that the robotic arms placed at the labial commissure of the mouth can reach the sella. From these anatomical features and previous cadaveric dissections, we assume that TORS may be feasible on a majority of patients to remove pituitary adenomas.
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Esteban F, Menoyo A, Abrante A. Critical Analysis of Robotic Surgery for Laryngeal Tumours. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2014. [DOI: 10.1016/j.otoeng.2014.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Análisis crítico de la cirugía robótica laríngea. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2014; 65:365-72. [DOI: 10.1016/j.otorri.2013.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 12/09/2013] [Indexed: 11/18/2022]
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Rackley T, Palaniappan N, Owens D, Evans M. Adjuvant treatment decisions for oropharyngeal cancer - is it time for a change? Clin Otolaryngol 2014; 39:316-21. [DOI: 10.1111/coa.12280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2014] [Indexed: 11/27/2022]
Affiliation(s)
| | | | - D. Owens
- University Hospital of Wales; Cardiff UK
| | - M. Evans
- Velindre Cancer Centre; Cardiff UK
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Feasibility and safety of transoral robotic surgery (TORS) for early hypopharyngeal cancer: a subset analysis of the Hamburg University TORS-trial. Eur Arch Otorhinolaryngol 2014; 272:2993-8. [DOI: 10.1007/s00405-014-3259-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 08/26/2014] [Indexed: 11/26/2022]
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Hammoudi K, Pinlong E, Kim S, Bakhos D, Morinière S. Transoral robotic surgery versus conventional surgery in treatment for squamous cell carcinoma of the upper aerodigestive tract. Head Neck 2014; 37:1304-9. [PMID: 24816480 DOI: 10.1002/hed.23752] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 03/21/2014] [Accepted: 05/07/2014] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The purpose of our work was to compare a group of patients undergoing transoral robotic surgery (TORS group) for squamous cell carcinoma of the upper aerodigestive tract and a matched group of patients undergoing conventional surgery (conventional surgery group) for the same indication. METHODS In this retrospective single-center study, 26 patients were included in each group. RESULTS There were significantly fewer tracheotomies in the TORS group (p < .001). The mean durations of feeding by nasogastric tube and hospitalization were shorter for the TORS group (p = .001). There was no significant difference in disease-free survival at 3 years (p = .76). Mean treatment cost was $7124 lower for the TORS group (p = .03). CONCLUSION This comparative study shows that robotic technology can be used to treat selected squamous cell carcinomas of the upper aerodigestive tract, reducing morbidity and treatment costs while providing equivalent cancer control at 3 years.
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Affiliation(s)
- Karim Hammoudi
- ENT Department, University François Rabelais.,CHRU Bretonneau, Tours Hospital, France
| | | | - Soo Kim
- CHRU Bretonneau, Tours Hospital, France
| | - David Bakhos
- ENT Department, University François Rabelais.,CHRU Bretonneau, Tours Hospital, France
| | - Sylvain Morinière
- ENT Department, University François Rabelais.,CHRU Bretonneau, Tours Hospital, France
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Transoral surgery using a novel single-port flexible endoscope system. Eur Arch Otorhinolaryngol 2014; 272:2451-6. [DOI: 10.1007/s00405-014-3177-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 06/23/2014] [Indexed: 10/25/2022]
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25
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Dombrée M, Crott R, Lawson G, Janne P, Castiaux A, Krug B. Cost comparison of open approach, transoral laser microsurgery and transoral robotic surgery for partial and total laryngectomies. Eur Arch Otorhinolaryngol 2014; 271:2825-34. [DOI: 10.1007/s00405-014-3056-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 04/07/2014] [Indexed: 11/24/2022]
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Hamzany Y, Brasnu D, Shpitzer T, Shvero J. Assessment of margins in transoral laser and robotic surgery. Rambam Maimonides Med J 2014; 5:e0016. [PMID: 24808954 PMCID: PMC4011481 DOI: 10.5041/rmmj.10150] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The growing practice of endoscopic surgery has changed the therapeutic management of selected head and neck cancers. Although a negative surgical margin in resection of neoplasm is the most important surgical principle in oncologic surgery, controversies exist regarding assessment and interpretation of the status of margin resection. The aim of this review was to summarize the literature considering the assessment and feasibility of negative margins in transoral laser microsurgery (TLM) and transoral robotic surgery (TORS). Free margin status is being approached differently in vocal cord cancer (1-2 mm) compared with other sites in the upper aerodigestive tract (2-5 mm). Exposure, orientation of the pathological specimen, and co-operation with the pathologist are crucial principles needed to be followed in transoral surgery. Piecemeal resection to better expose deep tumor involvement and biopsies taken from surgical margins surrounding site of resection can improve margin assessment. High rates of negative surgical margins can be achieved with TLM and TORS. Adjuvant treatment decision should take into consideration also the surgeon's judgment with regard to the completeness of tumor resection.
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Affiliation(s)
- Yaniv Hamzany
- Department of Otorhinolaryngology—Head and Neck Surgery, Rabin Medical Center, Petach Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel and
- To whom correspondence should be addressed. E-mail:
| | - Daniel Brasnu
- Department of Otorhinolaryngology—Head Neck Surgery, Université Paris Descartes, Sorbonne Paris Cité, Hôpital Européen Georges Pompidou, Assistance Publique—Hôpitaux de Paris, Paris, France
| | - Thomas Shpitzer
- Department of Otorhinolaryngology—Head and Neck Surgery, Rabin Medical Center, Petach Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel and
| | - Jacob Shvero
- Department of Otorhinolaryngology—Head and Neck Surgery, Rabin Medical Center, Petach Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel and
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[Principles of larynx surgery and nurse surveillance]. REVUE DE L'INFIRMIÈRE 2013:19-21. [PMID: 24245397 DOI: 10.1016/j.revinf.2013.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Endoscopic transoral surgical techniques have developed, adapted to forms of early stage larynx cancer. A total laryngectomy remains the only treatment for patients suffering from an advanced stage cancer which is not receptive to organ preservation strategies. For all these patients, nurse surveillance combines technical and relational care.
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Rinaldi V, Pagani D, Torretta S, Pignataro L. Transoral robotic surgery in the management of head and neck tumours. Ecancermedicalscience 2013; 7:359. [PMID: 24073017 PMCID: PMC3782590 DOI: 10.3332/ecancer.2013.359] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Indexed: 11/17/2022] Open
Abstract
The article reviews the use of robotic technology for head and neck tumours. The authors discuss the development of transoral robotic surgery (TORS), the current status of the technology, and the set-up in the operating room. The article provides a review of the literature, highlighting the applications, advantages, functional outcomes, and disadvantages of TORS for each anatomic subsite (oropharynx, hypopharynx, larynx, parapharyngeal space, and skull base). New challenges related to reconstruction are also presented. Overall early functional and oncologic outcome data are promising; further long-term prospective trials are still needed to confirm the oncological safety of TORS.
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Affiliation(s)
- Vittorio Rinaldi
- Department of Specialist Surgical Sciences, University of Milan, Otolaryngology Department, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
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Galbiatti ALS, Padovani-Junior JA, Maníglia JV, Rodrigues CDS, Pavarino ÉC, Goloni-Bertollo EM. Head and neck cancer: causes, prevention and treatment. Braz J Otorhinolaryngol 2013; 79:239-47. [PMID: 23670332 PMCID: PMC9443822 DOI: 10.5935/1808-8694.20130041] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Accepted: 08/10/2012] [Indexed: 11/25/2022] Open
Abstract
Abstract Although head and neck carcinoma ranks fifth among cancer types, patient survival rates have not changed significantly over the past years. Objective To determine the risk factors, causes, therapies, and prevention measures for head and neck cancer. Method Risk factors, causes, therapies, and preventive measures for this disease were searched on databases PUBMED, MEDLINE, and SciELO. Results Alcohol and tobacco are still atop risk factors. Other factors may influence the development of head and neck carcinoma. Surgery is the main treatment option, and the addition of radiotherapy following surgery is frequent for patients in the early stages of the disease. Other therapies target specific genetic molecular components connected to tumor development. Disease preventive measures include smoking cessation, limiting alcohol intake, preventing exposure to tobacco smoke and environmental carcinogenic agents, early detection of infection by HPV, maintaining oral health, good eating habits, and managing stress. Conclusion Additional research is needed for a more thorough understanding of the development of head and neck carcinomas and to shed light on new ways to improve therapeutic approaches and interventions.
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Affiliation(s)
- Ana Lívia Silva Galbiatti
- Research Unit for Molecular Biology and Genetics (UPGEM), São José do Rio Preto Medical School, Brazil
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Transoral robotic-assisted free flap reconstruction after radiation therapy in hypopharyngeal carcinoma: report of two cases. Eur Arch Otorhinolaryngol 2013; 270:2359-64. [DOI: 10.1007/s00405-013-2566-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2012] [Accepted: 05/14/2013] [Indexed: 12/28/2022]
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Current World Literature. Curr Opin Oncol 2013; 25:325-30. [DOI: 10.1097/cco.0b013e328360f591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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