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Louerat S, Hans S, Laroche S, Hyvrard C, Baudouin R. World premiere: transoral robot-assisted excision for nasopharyngeal ectopic pituitary adenoma. Eur Arch Otorhinolaryngol 2024; 281:6705-6709. [PMID: 39083058 DOI: 10.1007/s00405-024-08850-3] [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: 04/08/2024] [Accepted: 07/14/2024] [Indexed: 11/16/2024]
Abstract
BACKGROUND Pituitary adenoma (PA), though rare, has seen increased incidence with widespread MRI use, enabling incidental diagnosis. Prevalence is approximately 1 case per 1000 in the general population. PAs are benign neoplasms, constituting 10 to 20% of intracranial tumours. Ectopic pituitary adenoma developed outside the sella turcica is exceptional. It may be hormonally active or not. These are called nonfunctional pituitary adenomas. METHODS Here is reported a case of a man in his eighties with a nasopharyngeal ectopic pituitary adenoma treated by robot-assisted excision using a combined route. CARE guidelines have been respected. RESULTS A man in his eighties, asymptomatic, underwent an MRI for dizziness, revealing a nasopharyngeal mass. Despite being asymptomatic, nasofibroscopy revealed a reddish oval-shaped tissue mass attached to the roof of the nasopharynx. Biopsy identified a neuroendocrine tumor G1/G2. Imaging showed no local invasion or distant metastases. A multidisciplinary team decided on a robot-assisted surgical excision through the mouth, coupled with nasal endoscopy. The procedure achieved complete excision with clear margins and no adverse event has occurred. CONCLUSIONS This unique case involved the successful transoral robot-assisted excision of a nasopharyngeal ectopic pituitary adenoma, highlighting an innovative surgical approach.
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Affiliation(s)
- Serena Louerat
- Department of Otolaryngology-Head & Neck Surgery, Foch Hospital, 40 rue Worth, Suresnes, 92 150, France
- School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), 2 Av. de la Source de la Bièvre, Montigny-le-Bretonneux, 78 180, France
| | - Stéphane Hans
- Department of Otolaryngology-Head & Neck Surgery, Foch Hospital, 40 rue Worth, Suresnes, 92 150, France
- School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), 2 Av. de la Source de la Bièvre, Montigny-le-Bretonneux, 78 180, France
| | - Suzanne Laroche
- Department of Endocrinology and Diabetology, Foch Hospital, 40 rue Worth, Suresnes, 92 150, France
| | - Clementine Hyvrard
- Department of Otolaryngology-Head & Neck Surgery, Foch Hospital, 40 rue Worth, Suresnes, 92 150, France
- School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), 2 Av. de la Source de la Bièvre, Montigny-le-Bretonneux, 78 180, France
| | - Robin Baudouin
- Department of Otolaryngology-Head & Neck Surgery, Foch Hospital, 40 rue Worth, Suresnes, 92 150, France.
- School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), 2 Av. de la Source de la Bièvre, Montigny-le-Bretonneux, 78 180, France.
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Mehta A, Cheng Ng J, Andrew Awuah W, Huang H, Kalmanovich J, Agrawal A, Abdul-Rahman T, Hasan MM, Sikora V, Isik A. Embracing robotic surgery in low- and middle-income countries: Potential benefits, challenges, and scope in the future. Ann Med Surg (Lond) 2022; 84:104803. [PMID: 36582867 PMCID: PMC9793116 DOI: 10.1016/j.amsu.2022.104803] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 10/23/2022] [Indexed: 11/25/2022] Open
Abstract
Robotic surgery has applications in many medical specialties, including urology, general surgery, and surgical oncology. In the context of a widespread resource and personnel shortage in Low- and Middle-Income Countries (LMICs), the use of robotics in surgery may help to reduce physician burnout, surgical site infections, and hospital stays. However, a lack of haptic feedback and potential socioeconomic factors such as high implementation costs and a lack of trained personnel may limit its accessibility and application. Specific improvements focused on improved financial and technical support to LMICs can help improve access and have the potential to transform the surgical experience for both surgeons and patients in LMICs. This review focuses on the evolution of robotic surgery, with an emphasis on challenges and recommendations to facilitate wider implementation and improved patient outcomes.
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Affiliation(s)
- Aashna Mehta
- University of Debrecen-Faculty of Medicine, Debrecen, 4032, Hungary
| | - Jyi Cheng Ng
- Faculty of Medicine and Health Sciences, University of Putra Malaysia, Serdang, Malaysia
| | | | - Helen Huang
- Royal College of Surgeons in Ireland, University of Medicine and Health Science, Dublin, Ireland
| | | | - Aniket Agrawal
- Department of Pediatric Surgery, Center for Children, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | | | - Mohammad Mehedi Hasan
- Department of Biochemistry and Molecular Biology, Faculty of Life Science, Mawlana Bhashani Science and Technology University, Tangail, Bangladesh
| | - Vladyslav Sikora
- Sumy State University and Toufik's World Medical Association, Sumy, Ukraine
| | - Arda Isik
- Istanbul Medeniyet University, Department of General Surgery, Istanbul, Turkey
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Campbell RG, Harvey RJ. How close are we to anterior robotic skull base surgery? Curr Opin Otolaryngol Head Neck Surg 2021; 29:44-52. [PMID: 33337610 DOI: 10.1097/moo.0000000000000683] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
PURPOSE OF REVIEW The application of robotic surgery to anterior skull base disease has yet to be defined despite the potential for improved tumour resection with less morbidity in this region. Complex anatomy and restricted access have limited the development of robotic anterior skull base surgery. RECENT FINDINGS A limited number of transoral robotic surgical anterior skull base procedures have been undertaken; however, there are significant limitations to the utilization of this technology in the anterior skull base. In this article, the advantages, disadvantages and limitations of robotic anterior skull base surgery are discussed. Currently, the major limitation is the size of the robotic endoscope and of the available instrumentation. Technological advancements that provide promise for the future development of robotic anterior skull base surgery are in development, such as single-port robots, flexible instrument systems and miniaturization and growth of minimally invasive platforms. SUMMARY Although transnasal access to the skull base is not possible with the currently available robotic systems, promising technology does exist and is in development. Robotic anterior skull base surgery promises to provide greater access to skull base disease, improve oncologic results, reduce morbidity and to reduce the ergonomic burden on the surgeon.
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Affiliation(s)
- Raewyn G Campbell
- Faculty of Medicine, Health and Human Sciences, Macquarie University
- Department of Otolaryngology - Head and Neck Surgery, Royal Prince Alfred Hospital
- Rhinology and Skull Base Research Group, St. Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
| | - Richard J Harvey
- Faculty of Medicine, Health and Human Sciences, Macquarie University
- Rhinology and Skull Base Research Group, St. Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
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Chebib E, Lechien JR, Chekkoury Y, Hans S. Transoral Robotic Surgery for Cancer of the Soft Palate Posterior Surface. EAR, NOSE & THROAT JOURNAL 2020; 101:660-662. [PMID: 33263437 DOI: 10.1177/0145561320977463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The surgical treatment of oropharyngeal squamous cell carcinoma (OSCC) has undergone a considerable evolution, with, among others, transoral robotic surgery (TORS). However, TORS is rarely used for the surgery of soft palate. A 73-year-old man presented a human papilloma virus OSCC of the posterior soft palate. The tumor was resected using TORS. This report describes the surgical technique step by step of the tumor resection. The resection of early stage OSCC of the posterior surface of soft palate is possible through TORS. The procedure is noninvasive, rapid, and seems to be associated with excellent functional outcomes.
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Affiliation(s)
- Emilien Chebib
- Robotic Study Group of Young Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Marseille, France.,Department of Otorhinolaryngology and Head and Neck Surgery, 37918Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Jérôme R Lechien
- Robotic Study Group of Young Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Marseille, France.,Department of Otorhinolaryngology and Head and Neck Surgery, 37918Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Younes Chekkoury
- Robotic Study Group of Young Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Marseille, France.,Department of Otorhinolaryngology and Head and Neck Surgery, 37918Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Stéphane Hans
- Robotic Study Group of Young Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Marseille, France.,Department of Otorhinolaryngology and Head and Neck Surgery, 37918Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
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Soriano RM, Rindler RS, Helman SN, Pradilla G, Solares CA. Endoscopic transoral nasopharyngectomy. Head Neck 2020; 43:278-287. [PMID: 32996247 DOI: 10.1002/hed.26483] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 08/10/2020] [Accepted: 09/21/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND A minimal access technique for the management of nasopharyngeal tumors extending below the palatal plane and laterally beyond the pterygoid musculature is yet to be developed. In this study we demonstrate the feasibility of endoscopic transoral nasopharyngectomy (ETON) for resection of large nasopharyngeal lesions as a natural orifice alternative to traditional approaches. METHODS ETON was completed in three latex-injected specimens. Surgical freedom (SF) and angles of attack (AoA) were calculated along the internal carotid artery (ICA). RESULTS An endoscopic transoral approach was successfully used to identify the parapharyngeal ICA and subsequently perform a complete nasopharyngeal resection. SF and AoA (sagittal) were found to be the greatest at the anterior genu of the ICA. CONCLUSIONS ETON is feasible. It provides wide exposure of the skull base and proximal control of the ICA. It may be indicated for the management of nasopharyngeal tumors with inferolateral extension, involving the ICA.
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Affiliation(s)
- Roberto M Soriano
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Rima S Rindler
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Samuel N Helman
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College, New York, New York, USA
| | - Gustavo Pradilla
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - C Arturo Solares
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
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Gorphe P, Stein H, Moya-Plana A. Cervical-transoral robotic nasopharyngectomy: A preclinical study. Head Neck 2019; 42:394-400. [PMID: 31750609 DOI: 10.1002/hed.26013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/17/2019] [Accepted: 10/30/2019] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND We performed a preclinical study to assess the feasibility of the cervical-transoral robotic pharyngectomy procedure in surgery for nasopharyngeal cancer, where deep margins and vascular safety are key issues. MATERIALS AND METHODS Four cadaveric dissections were performed with the da Vinci Xi system. The first step was a robotic parapharyngeal dissection along the internal carotid artery (ICA). The second step was a type 3 transoral robotic nasopharyngectomy. RESULTS In each procedure, a comprehensive dissection of the parapharyngeal space was performed along the ICA up to the foramen lacerum. A type 3 nasopharyngectomy was performed transorally with an "en-bloc" removal of the parapharyngeal space, and with complete removal of the eustachian tube up to its bony part. CONCLUSION A comprehensive cervical-transoral robotic type 3 nasopharyngectomy with "en-bloc" removal of the parapharyngeal space and the eustachian tube proved to be technically feasible in a preclinical study.
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Affiliation(s)
- Philippe Gorphe
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France
| | - Hubert Stein
- Department of Global Clinical Development, Intuitive Surgical Inc., Sunnyvale, California
| | - Antoine Moya-Plana
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France
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Campbell RG. Robotic surgery of the anterior skull base. Int Forum Allergy Rhinol 2019; 9:1508-1514. [DOI: 10.1002/alr.22435] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 08/24/2019] [Accepted: 08/29/2019] [Indexed: 02/02/2023]
Affiliation(s)
- Raewyn G. Campbell
- Department of Otorhinolaryngology, Head and Neck SurgeryRoyal Prince Alfred Hospital Sydney NSW Australia
- Department of Otorhinolaryngology, Head and Neck SurgeryMacquarie University Hospital Sydney NSW Australia
- Department of Otorhinolaryngology, Head and Neck SurgeryThe Chris O'Brien Lifehouse Sydney NSW Australia
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