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Zhang C, Wei R, Mo H, Zhai Y, Sun D. Deep learning-assisted 3D laser steering using an optofluidic laser scanner. BIOMEDICAL OPTICS EXPRESS 2024; 15:1668-1681. [PMID: 38495701 PMCID: PMC10942714 DOI: 10.1364/boe.514489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 12/26/2023] [Accepted: 12/27/2023] [Indexed: 03/19/2024]
Abstract
Laser ablation is an effective treatment modality. However, current laser scanners suffer from laser defocusing when scanning targets at different depths in a 3D surgical scene. This study proposes a deep learning-assisted 3D laser steering strategy for minimally invasive surgery that eliminates laser defocusing, increases working distance, and extends scanning range. An optofluidic laser scanner is developed to conduct 3D laser steering. The optofluidic laser scanner has no mechanical moving components, enabling miniature size, lightweight, and low driving voltage. A deep learning-based monocular depth estimation method provides real-time target depth estimation so that the focal length of the laser scanner can be adjusted for laser focusing. Simulations and experiments indicate that the proposed method can significantly increase the working distance and maintain laser focusing while performing 2D laser steering, demonstrating the potential for application in minimally invasive surgery.
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Affiliation(s)
- Chunqi Zhang
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong SAR, 999077, China
| | - Ruofeng Wei
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong SAR, 999077, China
| | - Hangjie Mo
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong SAR, 999077, China
| | - Yujia Zhai
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong SAR, 999077, China
| | - Dong Sun
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong SAR, 999077, China
- Center of Robotics and Automation, Shenzhen Research Institute, Shenzhen, Guangdong, 518000, China
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2
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San Juan JD, Mendelsohn AH. Evaluation and application of CO 2 laser fiber delivery for single port transoral robotic surgery. Int J Med Robot 2023:e2510. [PMID: 36791776 DOI: 10.1002/rcs.2510] [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: 11/13/2022] [Revised: 02/01/2023] [Accepted: 02/13/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Transoral robotic surgery (TORS) using the Single-Port system (SPS) relies on electrocautery, limiting its applications in the upper aerodigestive tract. We evaluated the feasibility of a CO2 delivery system for the SPS. METHODS Otolaryngology residents performed a cutting exercise using a handheld CO2 laser and participated in a cadaveric oropharyngeal dissection using the SPS with monopolar cautery (SP + EC) and CO2 laser (SP + CO2 ). Residents completed the System Usability Scale (SUS) questionnaire to evaluate these techniques. RESULTS The same laser fiber was used for all combined dissections. The handheld CO2 laser, SP + EC, and SP + CO2 demonstrated similar SUS scores. On individual domain scores, SP + CO2 received less favorable ratings compared to the handheld CO2 laser for complexity, integration, and cumbersome experience (p < 0.05). On subgroup stratification, less TORS experience was associated with worse SUS scores. CONCLUSION SP-guided CO2 laser delivery is a viable alternative to electrocautery in robotic surgery, and should be considered when performing TORS.
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Affiliation(s)
- Juan D San Juan
- UCLA David Geffen School of Medicine Department of Head and Neck Surgery, Los Angeles, California, USA
| | - Abie H Mendelsohn
- UCLA David Geffen School of Medicine Department of Head and Neck Surgery, Los Angeles, California, USA
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3
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Hans S, Baudouin R, Circiu MP, Couineau F, Lisan Q, Crevier-Buchman L, Lechien JR. Laryngeal Cancer Surgery: History and Current Indications of Transoral Laser Microsurgery and Transoral Robotic Surgery. J Clin Med 2022; 11:jcm11195769. [PMID: 36233637 PMCID: PMC9571943 DOI: 10.3390/jcm11195769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/23/2022] [Accepted: 09/24/2022] [Indexed: 11/21/2022] Open
Abstract
The development of transoral laser microsurgery (TLM) was an important step in the history of conservative laryngeal surgery. TLM reported comparable oncological outcomes and better functional postoperative and rehabilitation outcomes than open partial laryngectomy. TLM is currently considered as the standard surgical approach for early-stage laryngeal carcinoma. However, TLM has many limitations, including the limited view of the surgical field through the laryngoscope, exposure difficulties for some tumor locations, and a long learning curve. The development of transoral robotic surgery (TORS) appears to be an important issue to overcome these limitations. The current robotic technologies used in surgery benefited from the research of the U.S. Military and National Aeronautics and Space Administration (NASA) in the 1970s and 1980s. The first application in humans started in the 2000s with the first robotic-assisted cholecystectomy in the US, performed by a surgeon located in France. The use of robots in otolaryngology occurred after the development of the Da Vinci system in digestive surgery, urology, and gynecology, and mainly concerns cT1-T2 and some selected cT3 oropharyngeal and supraglottic carcinomas. With the development of a new robotic system with smaller arms and instruments, TORS indications will probably evolve in the next few years, leading to better outcomes for laryngeal or hypopharyngeal carcinomas.
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Affiliation(s)
- Stéphane Hans
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), 92150 Paris, France
| | - Robin Baudouin
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), 92150 Paris, France
| | - Marta P. Circiu
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), 92150 Paris, France
| | - Florent Couineau
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), 92150 Paris, France
| | - Quentin Lisan
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), 92150 Paris, France
| | - Lise Crevier-Buchman
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), 92150 Paris, France
| | - Jerome R. Lechien
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), 92150 Paris, France
- Division of Laryngology and Broncho-Esophagology, EpiCURA Hospital, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), 7000 Mons, Belgium
- Polyclinic of Poitiers—Elsan, 86000 Poitiers, France
- Correspondence:
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4
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Mo H, Li X, Ouyang B, Fang G, Jia Y. Task Autonomy of a Flexible Endoscopic System for Laser-Assisted Surgery. CYBORG AND BIONIC SYSTEMS 2022; 2022:9759504. [PMID: 38616915 PMCID: PMC11014730 DOI: 10.34133/2022/9759504] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 08/01/2022] [Indexed: 04/16/2024] Open
Abstract
Laser beam steering has been widely studied for the automation of surgery. Currently, flexible instruments for laser surgery are operated entirely by surgeons, which keeps the automation of endoluminal surgery at the initial level. This paper introduces the design of a new workflow that enables the task autonomy of laser-assisted surgery in constrained environments such as the gastrointestinal (GI) tract with a flexible continuum robotic system. Unlike current, laser steering systems driven by piezoelectric require the use of high voltage and are risky. This paper describes a tendon-driven 2 mm diameter flexible manipulator integrated with an endoscope to steer the laser beam. By separating its motion from the total endoscopic system, the designed flexible manipulator can automatically manipulate the laser beam. After the surgical site is searched by the surgeon with a master/slave control, a population-based model-free control method is applied for the flexible manipulator to achieve accurate laser beam steering while overcoming the noise from the visual feedback and disturbances from environment during operation. Simulations and experiments are performed with the system and control methods to demonstrate the proposed framework in a simulated constrained environment.
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Affiliation(s)
- Hangjie Mo
- Hong Kong Centre for Cerebro-Cardiovascular Health Engineering, Hong KongChina
| | - Xiaojian Li
- School of Management, Hefei University of Technology, Hefei, China
| | - Bo Ouyang
- School of Management, Hefei University of Technology, Hefei, China
| | - Ge Fang
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong, China
| | - Yuanjun Jia
- Department of Automation, University of Science and Technology of China, Hefei, China
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5
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Meulemans J, Vandebroek T, Ourak M, Vander Poorten E, Vander Poorten V. Preclinical implementation of a steerable, Da Vinci Xi® compatible CO 2 -laser fibre carrier for transoral robotic surgery (TORS): A cadaveric feasibility study. Int J Med Robot 2021; 18:e2342. [PMID: 34652069 DOI: 10.1002/rcs.2342] [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: 06/07/2021] [Revised: 10/02/2021] [Accepted: 10/12/2021] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Monopolar electrocautery is the most common dissection and coagulation tool during transoral robotic surgery (TORS) but causes significant collateral tissue damage as opposed to CO2 laser. We aimed at combining both modalities in one robotic instrument arm. METHODS We developed a steerable CO2 -laser fibre carrier serving as an add-on to the existing Endowrist® monopolar spatula of the Da Vinci Xi. Feasibility and safety were assessed in a preclinical setting. RESULTS One radical tonsillectomy with monopolar cautery and three with the instrument prototype were performed in two cadavers by two surgeons. No serious prototype-related intra-operative difficulties were observed. Safe and efficient switching between energy sources proved possible in all simulated intra-operative bleeding events. Prototype use allowed for the identification of the majority of key anatomical structures and was scored favourably on NASA-TLX questionnaires. DISCUSSION The reported prototype successfully combines the advantages of CO2 -laser with the advantages of TORS.
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Affiliation(s)
- Jeroen Meulemans
- Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| | - Tom Vandebroek
- Department of Mechanical Engineering, KU Leuven, Leuven, Belgium
| | - Mouloud Ourak
- Department of Mechanical Engineering, KU Leuven, Leuven, Belgium
| | | | - Vincent Vander Poorten
- Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
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6
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Mattos LS, Acemoglu A, Geraldes A, Laborai A, Schoob A, Tamadazte B, Davies B, Wacogne B, Pieralli C, Barbalata C, Caldwell DG, Kundrat D, Pardo D, Grant E, Mora F, Barresi G, Peretti G, Ortiz J, Rabenorosoa K, Tavernier L, Pazart L, Fichera L, Guastini L, Kahrs LA, Rakotondrabe M, Andreff N, Deshpande N, Gaiffe O, Renevier R, Moccia S, Lescano S, Ortmaier T, Penza V. μRALP and Beyond: Micro-Technologies and Systems for Robot-Assisted Endoscopic Laser Microsurgery. Front Robot AI 2021; 8:664655. [PMID: 34568434 PMCID: PMC8455830 DOI: 10.3389/frobt.2021.664655] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 07/14/2021] [Indexed: 01/05/2023] Open
Abstract
Laser microsurgery is the current gold standard surgical technique for the treatment of selected diseases in delicate organs such as the larynx. However, the operations require large surgical expertise and dexterity, and face significant limitations imposed by available technology, such as the requirement for direct line of sight to the surgical field, restricted access, and direct manual control of the surgical instruments. To change this status quo, the European project μRALP pioneered research towards a complete redesign of current laser microsurgery systems, focusing on the development of robotic micro-technologies to enable endoscopic operations. This has fostered awareness and interest in this field, which presents a unique set of needs, requirements and constraints, leading to research and technological developments beyond μRALP and its research consortium. This paper reviews the achievements and key contributions of such research, providing an overview of the current state of the art in robot-assisted endoscopic laser microsurgery. The primary target application considered is phonomicrosurgery, which is a representative use case involving highly challenging microsurgical techniques for the treatment of glottic diseases. The paper starts by presenting the motivations and rationale for endoscopic laser microsurgery, which leads to the introduction of robotics as an enabling technology for improved surgical field accessibility, visualization and management. Then, research goals, achievements, and current state of different technologies that can build-up to an effective robotic system for endoscopic laser microsurgery are presented. This includes research in micro-robotic laser steering, flexible robotic endoscopes, augmented imaging, assistive surgeon-robot interfaces, and cognitive surgical systems. Innovations in each of these areas are shown to provide sizable progress towards more precise, safer and higher quality endoscopic laser microsurgeries. Yet, major impact is really expected from the full integration of such individual contributions into a complete clinical surgical robotic system, as illustrated in the end of this paper with a description of preliminary cadaver trials conducted with the integrated μRALP system. Overall, the contribution of this paper lays in outlining the current state of the art and open challenges in the area of robot-assisted endoscopic laser microsurgery, which has important clinical applications even beyond laryngology.
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Affiliation(s)
| | | | | | - Andrea Laborai
- Department of Otorhinolaryngology, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | | | - Brahim Tamadazte
- Institut des Systèmes Intelligents et de Robotique, Sorbonne Université, CNRS, Paris, France
| | | | - Bruno Wacogne
- FEMTO-ST Institute, Univ. Bourgogne Franche-Comte, CNRS, Besançon, France.,Centre Hospitalier Régional Universitaire, Besançon, France
| | - Christian Pieralli
- FEMTO-ST Institute, Univ. Bourgogne Franche-Comte, CNRS, Besançon, France
| | - Corina Barbalata
- Mechanical and Industrial Engineering Department, Louisiana State University, Baton Rouge, LA, United States
| | | | | | - Diego Pardo
- Istituto Italiano di Tecnologia, Genoa, Italy
| | - Edward Grant
- Department of Electrical and Computer Engineering, North Carolina State University, Raleigh, NC, United States
| | - Francesco Mora
- Clinica Otorinolaringoiatrica, IRCCS Policlinico San Martino, Genoa, Italy.,Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate, Università Degli Studi di Genova, Genoa, Italy
| | | | - Giorgio Peretti
- Clinica Otorinolaringoiatrica, IRCCS Policlinico San Martino, Genoa, Italy.,Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate, Università Degli Studi di Genova, Genoa, Italy
| | - Jesùs Ortiz
- Istituto Italiano di Tecnologia, Genoa, Italy
| | - Kanty Rabenorosoa
- FEMTO-ST Institute, Univ. Bourgogne Franche-Comte, CNRS, Besançon, France
| | | | - Lionel Pazart
- Centre Hospitalier Régional Universitaire, Besançon, France
| | - Loris Fichera
- Department of Robotics Engineering, Worcester Polytechnic Institute, Worcester, MA, United States
| | - Luca Guastini
- Clinica Otorinolaringoiatrica, IRCCS Policlinico San Martino, Genoa, Italy.,Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate, Università Degli Studi di Genova, Genoa, Italy
| | - Lüder A Kahrs
- Department of Mathematical and Computational Sciences, University of Toronto, Mississauga, ON, Canada
| | - Micky Rakotondrabe
- National School of Engineering in Tarbes, University of Toulouse, Tarbes, France
| | - Nicolas Andreff
- FEMTO-ST Institute, Univ. Bourgogne Franche-Comte, CNRS, Besançon, France
| | | | - Olivier Gaiffe
- Centre Hospitalier Régional Universitaire, Besançon, France
| | - Rupert Renevier
- FEMTO-ST Institute, Univ. Bourgogne Franche-Comte, CNRS, Besançon, France
| | - Sara Moccia
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Sergio Lescano
- FEMTO-ST Institute, Univ. Bourgogne Franche-Comte, CNRS, Besançon, France
| | - Tobias Ortmaier
- Institute of Mechatronic Systems, Leibniz Universität Hannover, Garbsen, Germany
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7
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Rosenthal M, Baser RE, Migliacci J, Boyle JO, Morris LGT, Cohen MA, Singh B, Shah JP, Wong RJ, Patel S, Ganly I. Flexible fiber-based CO 2 laser vs monopolar cautery for resection of oral cavity lesions: A single center randomized controlled trial assessing pain and quality of life following surgery. Laryngoscope Investig Otolaryngol 2021; 6:690-698. [PMID: 34401493 PMCID: PMC8356859 DOI: 10.1002/lio2.572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 02/06/2021] [Accepted: 04/17/2021] [Indexed: 11/05/2022] Open
Abstract
IMPORTANCE This study reports the impact of laser surgery on quality of life in patients with oral cavity lesions. OBJECTIVE To compare postoperative pain and quality of life in patients treated with flexible fiberoptic CO2 laser vs electrocautery in patients with oral cavity precancerous lesions and early stage cancers. DESIGN Randomized controlled trial. SETTING Single center. PARTICIPANTS Patients with premalignant oral cavity lesions and early stage oral cancer. INTERVENTION Patients were randomized to have surgical resection using either flexible fiber carbon dioxide laser (Laser) or electrocautery (EC). The patients were then followed over a period of 28 days to assess for outcomes including pain, quality of life, performance status, return to work, and return to diet. Quality of life was measured by the University of Washington Quality of Life (UWQOL) questionnaire and the performance status score (PSS). MAIN OUTCOME MEASURE The primary endpoint for this study was the numerical pain rating on postoperative day (POD) 7. RESULTS Sixty-two patients were randomized (32 laser and 30 electrocautery). Lesions excised were carcinoma in 30(48%), dysplasia in 31(50%) and benign in 1(2%). There was no difference in the location of lesion, size of lesion, defect size, type of closure, resection time, and blood loss between Laser and EC arms. Patients who had Laser had less pain compared to EC (mean pain score on POD 7 L = 2.84 vs EC = 3.83, P = 0.11). better UW QOL scores and PSS scores, quicker return to normal diet (median days L = 26.0 vs EC = 28.5, P = 0.17) and faster return to work (median days L = 13.0 vs EC = 16.5, P = 0.14). However, these results were not statistically significant. CONCLUSION There was a trend for patients treated with laser to have less pain and better quality of life scores but these result were not statistically significant. Based on the actual observed difference, a large multicenter RCT with 90 patients in each arm is required to determine the clinical relevance of our results.
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Affiliation(s)
- Matthew Rosenthal
- Department of SurgeryHead and Neck Service, Memorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Raymond E. Baser
- Department of Epidemiology and BiostatisticsMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Jocelyn Migliacci
- Department of SurgeryHead and Neck Service, Memorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Jay O. Boyle
- Department of SurgeryHead and Neck Service, Memorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Luc G. T. Morris
- Department of SurgeryHead and Neck Service, Memorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Marc A. Cohen
- Department of SurgeryHead and Neck Service, Memorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Bhuvanesh Singh
- Department of SurgeryHead and Neck Service, Memorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Jatin P. Shah
- Department of SurgeryHead and Neck Service, Memorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Richard J. Wong
- Department of SurgeryHead and Neck Service, Memorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Snehal Patel
- Department of SurgeryHead and Neck Service, Memorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Ian Ganly
- Department of SurgeryHead and Neck Service, Memorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
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8
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Turner MT, Stokes WA, Stokes CM, Hassid S, Holsinger FC, Lawson G. Airway and bleeding complications of transoral robotic supraglottic laryngectomy (TORS-SGL): A systematic review and meta-analysis. Oral Oncol 2021; 118:105301. [PMID: 33940531 DOI: 10.1016/j.oraloncology.2021.105301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 04/06/2021] [Indexed: 01/21/2023]
Affiliation(s)
- Meghan T Turner
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University Health Sciences Center, Morgantown, West Virginia, USA
| | - William A Stokes
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University Health Sciences Center, Morgantown, West Virginia, USA.
| | - Cara M Stokes
- Department of Epidemiology, School of Public Health, West Virginia University Health Sciences Center, Morgantown, WV., USA
| | - Samantha Hassid
- Department of Otolaryngology-Head and Neck Surgery, Université Catholique de Louvain Centre Hospitalier Universitaire de Mont-Godinne, Yvoir, Belgium
| | - F Christopher Holsinger
- Division of Head and Neck Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University Medical Center, Palo Alto, CA, USA
| | - Georges Lawson
- Department of Otolaryngology-Head and Neck Surgery, Université Catholique de Louvain Centre Hospitalier Universitaire de Mont-Godinne, Yvoir, Belgium
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9
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Hans S, Chekkoury-Idrissi Y, Circiu MP, Distinguin L, Crevier-Buchman L, Lechien JR. Surgical, Oncological, and Functional Outcomes of Transoral Robotic Supraglottic Laryngectomy. Laryngoscope 2020; 131:1060-1065. [PMID: 32812245 DOI: 10.1002/lary.28926] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 06/09/2020] [Accepted: 06/17/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS To investigate the surgical, oncological, and functional outcomes of transoral robotic surgery (TORS) for the treatment of supraglottic squamous cell carcinoma. STUDY DESIGN Retrospective chart review. METHODS The charts of patients treated by TORS supraglottic laryngectomy (SGL) in an academic medical center were reviewed. The following outcomes were studied according to the tumor location: average robotic setup and operative times, mean estimated blood loss, postoperative complications, need of tracheotomy, refeeding characteristics, mean hospital stay, need of neck dissection and adjuvant therapy, 5-year local and regional controls, overall survival (OS), and disease-free survival (DFS). RESULTS Seventy-five patients underwent TORS SGL. Tumors were classified as cT1 (32%), cT2 (52%), and cT3 (16%). Average robotic setup and operative times and the mean estimated blood loss were 15 minutes, 55 minutes, and 20 mL, respectively. The mean follow-up period ranged from 2 to 5 years. The 5-year OS and DFS were 80.2% and 94.3%, respectively. Overall, 34.6% of patients received adjuvant radiotherapy. The majority of patients (92%) restarted an oral diet within 24 to 48 hours postsurgery. Transient tracheotomy was performed in 8% of patients. Postoperative hemorrhages occurred in 12 patients (16.0%), lengthening the hospital stay (mean = 6.8 days). There were no outcome differences regarding the tumor location. CONCLUSIONS TORS is an effective and safe therapeutic approach for early- and intermediate-stages cancers. Oncological outcomes may be quite similar to other surgical approaches, including transoral laser and open surgeries. Future randomized controlled studies are needed for comparing TORS SGL with other surgical procedures. LEVEL OF EVIDENCE 4 Laryngoscope, 131:1060-1065, 2021.
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Affiliation(s)
- Stéphane Hans
- Robotic Study Group of Young-Otolaryngologists of the International Federations of Otorhinolaryngological Societies (YO-IFOS), Paris, France.,Department of Otorhinolaryngology-Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Younès Chekkoury-Idrissi
- Robotic Study Group of Young-Otolaryngologists of the International Federations of Otorhinolaryngological Societies (YO-IFOS), Paris, France.,Department of Otorhinolaryngology-Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Marta P Circiu
- Robotic Study Group of Young-Otolaryngologists of the International Federations of Otorhinolaryngological Societies (YO-IFOS), Paris, France.,Department of Otorhinolaryngology-Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Léa Distinguin
- Robotic Study Group of Young-Otolaryngologists of the International Federations of Otorhinolaryngological Societies (YO-IFOS), Paris, France.,Department of Otorhinolaryngology-Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Lise Crevier-Buchman
- Robotic Study Group of Young-Otolaryngologists of the International Federations of Otorhinolaryngological Societies (YO-IFOS), Paris, France.,Department of Otorhinolaryngology-Head and Neck Surgery, Foch 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 Otorhinolaryngological Societies (YO-IFOS), Paris, France.,Department of Otorhinolaryngology-Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France.,Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium
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10
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Lechien JR, Fakhry N, Saussez S, Chiesa-Estomba CM, Chekkoury-Idrissi Y, Cammaroto G, Melkane AE, Barillari MR, Crevier-Buchman L, Ayad T, Remacle M, Hans S. Surgical, clinical and functional outcomes of transoral robotic surgery for supraglottic laryngeal cancers: A systematic review. Oral Oncol 2020; 109:104848. [PMID: 32534362 DOI: 10.1016/j.oraloncology.2020.104848] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/30/2020] [Accepted: 06/03/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aim of this systematic review is to shed light the current indications and outcomes of transoral robotic surgery (TORS) supraglottic laryngectomy (SGL) in patients with supraglottic laryngeal cancer. METHODS PubMed, Scopus and Cochrane Library were searched by three independent otolaryngologists from the Young Otolaryngologists of IFOS for studies investigating the indications, effectiveness and safety of TORS SGL. Surgical, functional, and survival outcomes have been investigated. Inclusion/exclusion criteria; demographic data; and clinical outcome evaluation of papers were analyzed using PRISMA criteria. RESULTS A total of 14 papers met our inclusion criteria, accounting for 422 patients (335 males & 87 females). The tumor location mainly consisted of epiglottis (55.4%), aryepglottic fold (31.2%), and ventricular band (5.1%). The following tumor stages were considered: cT1 (35.8%); cT2 (48.6%) and cT3 (13.9%). Feeding tube and percutaneous endoscopic gastrostomy were used in 62.5% and 8.82% of patients, respectively. The 24-month local & regional control rates ranged from 94.3% to 100% and 87.5% to 94.0%, respectively. The 2-year and 5-year overall survival rates ranged from 66.7% to 88.0% and 78.7% to 80.2%, respectively. There was an important heterogeneity between studies with regard to the inclusion/exclusion criteria, follow-up times, complications analysis; surgical and functional outcomes. CONCLUSION TORS SGL is an effective approach for treating patients with early stages supraglottic cancers. Future controlled studies are needed to compare functional and survival outcomes between TORS SGL and other surgical approaches. Recommendations have been provided for future studies for better inclusion of patients, analysis of complications and functional outcomes.
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Affiliation(s)
- Jerome R Lechien
- Robotic Surgery Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), France; Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium; Department of Otolaryngology-Head Neck Surgery, Foch Hospital, UFR Simone Veil, University Versailles Saint-Quentin-en Yvelines (University Paris Saclay), Paris, France; Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium.
| | - Nicolas Fakhry
- Robotic Surgery Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), France; Department of Otorhinolaryngology-Head & Neck Surgery, APHM, Aix Marseille University, La Conception University Hospital, Marseille, France
| | - Sven Saussez
- Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium; Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Carlos-Miguel Chiesa-Estomba
- Robotic Surgery Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), France; Department of Otorhinolaryngology-Head & Neck Surgery, Hospital Universitario Donostia, San Sebastian, Spain
| | - Younes Chekkoury-Idrissi
- Robotic Surgery Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), France; Department of Otolaryngology-Head Neck Surgery, Foch Hospital, UFR Simone Veil, University Versailles Saint-Quentin-en Yvelines (University Paris Saclay), Paris, France
| | - Giovanni Cammaroto
- Robotic Surgery Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), France; Unit of Otolaryngology, Hospital Morgagni Pierantoni, Forlì, Italy
| | - Antoine E Melkane
- Robotic Surgery Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), France; Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Maria Rosaria Barillari
- Robotic Surgery Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), France; Division of Phoniatrics and Audiology, Department of Mental and Physical Health and Preventive Medicine, University of Naples SUN, Naples, Italy
| | - Lise Crevier-Buchman
- Robotic Surgery Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), France; Department of Otolaryngology-Head Neck Surgery, Foch Hospital, UFR Simone Veil, University Versailles Saint-Quentin-en Yvelines (University Paris Saclay), Paris, France
| | - Tareck Ayad
- Robotic Surgery Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), France; Centre Hospitalier de l'Université de Montréal, Department of Otolaryngology-Head & Neck Surgery, Montreal, Quebec, Canada
| | - Marc Remacle
- Robotic Surgery Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), France; Department of Otorhinolaryngology and Head and Neck Surgery, CH Luxembourg, Luxembourg
| | - Stéphane Hans
- Robotic Surgery Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), France; Department of Otolaryngology-Head Neck Surgery, Foch Hospital, UFR Simone Veil, University Versailles Saint-Quentin-en Yvelines (University Paris Saclay), Paris, France
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11
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Ross T, Tolley NS, Awad Z. Novel Energy Devices in Head and Neck Robotic Surgery - A Narrative Review. ROBOTIC SURGERY : RESEARCH AND REVIEWS 2020; 7:25-39. [PMID: 32426397 PMCID: PMC7187864 DOI: 10.2147/rsrr.s247455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 04/06/2020] [Indexed: 01/06/2023]
Abstract
The advent of trans-oral robotic surgery (TORS) has facilitated removal of tumors previously deemed unresectable, by providing access to the deep structures of the head and neck. Despite this, the wider dissemination of TORS has been restricted due to issues with line of access, as the da Vinci robot was never designed with head and neck surgery in mind. Flexible instruments and novel energy delivery devices offer great potential in overcoming some of the existing challenges surrounding TORS. This review aimed to summarize the existing literature surrounding energy delivery in TORS and highlight areas of future innovation. MEDLINE was searched for studies relating to energy delivery in TORS in November 2019. The existing literature surrounding monopolar and bipolar electrocautery, LASER (CO2, Tm:YAG and blue LASER), Ligasure and Harmonic was reviewed. Additionally, the latest iteration of the da Vinci; the SP, and the FLEX robot were evaluated as novel methods of energy delivery in TORS. Overall, these novel energy devices and robotic systems are predicted to further improve energy delivery to the head and neck. The use of flexible LASER in particular is well substantiated in the literature. This has the potential to achieve treatment de-escalation, based on the excellent outcomes demonstrated for disease-free margins and post-operative morbidity.
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Affiliation(s)
- Talisa Ross
- Department of Ear, Nose and Throat Surgery, London North West University Healthcare NHS Trust, London, UK.,Faculty of Medicine, Imperial College London, London, UK
| | - Neil S Tolley
- Faculty of Medicine, Imperial College London, London, UK.,Department of Ear, Nose and Throat Surgery, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Zaid Awad
- Faculty of Medicine, Imperial College London, London, UK.,Department of Ear, Nose and Throat Surgery, Imperial College Healthcare NHS Foundation Trust, London, UK
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Transoral Robot-Assisted Surgery in Supraglottic and Oropharyngeal Squamous Cell Carcinoma: Laser Versus Monopolar Electrocautery. J Clin Med 2019; 8:jcm8122166. [PMID: 31817848 PMCID: PMC6947577 DOI: 10.3390/jcm8122166] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 12/03/2019] [Accepted: 12/04/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Monopolar electrocautery (EC) is the surgical cutting and haemostatic tool most commonly used for transoral robotic surgery (TORS). The aim of this study was to retrospectively compare EC efficacy in the treatment of patients affected by T1 or T2 oropharyngeal and supraglottic squamous cell carcinomas with the more recently introduced laser fibres. METHODS We considered all TORS patients admitted to our department from January 2010 to June 2019. The outcomes of patients treated with Thulium: yttrium aluminium garnet (YAG) laser (TY-TORS), CO2 laser (CO2-TORS) and EC (EC-TORS) were analysed in order to assess surgical performances, functional outcomes and postoperative complications. RESULTS Twenty patients satisfied the enrolling criteria, of which nine underwent laser-TORS, and the remaining 11 underwent EC-TORS. In all candidates, TORS procedures were completed without the need for microscopic/open conversion. Close or positive margins were significantly more frequent in EC-TORS (p = 0.028). A considerable difference was found in overall functional parameters: times of nasogastric tube and tracheostomy removal and time of hospital discharge were significantly shorter in laser-TORS (p = 0.04, p = 0.05, p = 0.04, respectively). CONCLUSIONS Laser-TORS showed better results in comparison with EC-TORS in term of tumour resection margins and patient functional outcomes. Our findings can be justified with the greater tissue thermal damage caused by EC-TORS, despite prospective randomized trials and increased patient numbers being needed to confirm these preliminary conclusions.
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13
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Meta-analytic comparison of robotic and transoral laser surgical procedures in supraglottic carcinoma. J Laryngol Otol 2019; 133:404-412. [DOI: 10.1017/s0022215119000707] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectiveTo assess published reports of oncological surgical success rates in patients who underwent transoral laser supraglottic surgery and robotic surgery for supraglottic cancer.MethodsA systematic review of the literature was conducted and a meta-analysis of published data was performed. PubMed, Sage, Medline and Cochrane data sources were investigated. Overall survival rates, disease-specific survival rates, additional treatments and recurrence rates were investigated to determine the success of the surgical procedures.ResultsThe meta-analysis included 24 studies; 1617 studies were excluded. There were no statistically significant differences between the transoral laser supraglottic surgery and transoral robotic supraglottic surgery groups in terms of overall survival (77.0 per cent and 82.4 per cent respectively) and disease-specific survival (75.8 per cent and 87.0 per cent respectively). There was recurrence in 164 out of 832 patients (19.7 per cent) in the transoral laser supraglottic surgery group and in only 6 out of 66 patients (9 per cent) in the transoral robotic supraglottic surgery group.ConclusionTransoral laser surgery and robotic surgery appear to have comparable and acceptable oncological success rates.
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Chauhan M, Deshpande N, Caldwell DG, Mattos LS. Design and Modeling of a Three-Degree-of-Freedom Articulating Robotic Microsurgical Forceps for Trans-Oral Laser Microsurgery. J Med Device 2019. [DOI: 10.1115/1.4043017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Trans-oral laser microsurgery (TLM) is a surgical procedure for removing malignancies (e.g., cysts, polyps, tumors) of the laryngeal region through laser ablation. Intraoperative microsurgical forceps (i.e., microforceps) are used for tissue manipulation. The microforceps are rigid, single degree-of-freedom (DOF) devices (open–close) with precurved jaws to access different parts of the curved cylindrical laryngeal region. These microforceps are manually handled and are subject to hand tremors, poor reachability, and nonergonomic use, resulting in poor efficacy and efficiency in the surgery. A novel 3DOF motorized microforceps device is presented here, integrated with a 6DOF serial robotic manipulator. The device, referred to as RMF-3, offers three motorized DOFs: (i) open–close forceps jaw; (ii) tool rotation; and (iii) tool-tip articulation. It is designed to be compliant with TLM spatial constraints. The manual handling is replaced by tele-operation device, the omega.7. The design of the RMF-3 is characterized through theoretical and experimental analysis. The device shows a maximum articulation of 38 deg and tool rotation of 100 deg. Its performance is further evaluated through user trials using the ring-in-loop setup. The user trials demonstrate benefits of the 3DOF workspace of the device along with its teleoperation control. RMF-3 offers an improved workspace and reachability within the laryngeal region. Surgeons, in their preliminary evaluation of the device, appreciated the ability to articulate the tip, along with rotation, for hard-to-reach parts of the surgical site. RMF-3 offers an ergonomic robotic teleoperation control interface which overcomes hand tremors and extreme wrist excursion which leads to surgeon pain and discomfort.
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Affiliation(s)
- Manish Chauhan
- Storm Lab, School of Electronics and Electrical Engineering, University of Leeds, Leeds LS2 9JT, UK e-mail:
| | - Nikhil Deshpande
- Advanced Robotics Department, Istituto Italiano di Tecnologia, Via Morego, 30, Genova 16163, Italy e-mail:
| | - Darwin G. Caldwell
- Advanced Robotics Department, Istituto Italiano di Tecnologia, Via Morego, 30, Genova 16163, Italy e-mail:
| | - Leonardo S. Mattos
- Advanced Robotics Department, Istituto Italiano di Tecnologia, Via Morego, 30, Genova 16163, Italy e-mail:
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15
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Orosco RK, Tam K, Nakayama M, Holsinger FC, Spriano G. Transoral supraglottic laryngectomy using a next‐generation single‐port robotic surgical system. Head Neck 2019; 41:2143-2147. [DOI: 10.1002/hed.25676] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 12/04/2018] [Accepted: 01/09/2019] [Indexed: 11/11/2022] Open
Affiliation(s)
- Ryan K. Orosco
- Division of Head and Neck Surgery, Department of SurgeryUniversity of California San Diego California
| | - Kenric Tam
- Division of Head and Neck Surgery, Department of OtolaryngologyStanford University California
| | - Meijin Nakayama
- Department of Otolaryngology‐Head and Neck SurgeryYokohama City University Yokohama Japan
| | | | - Giuseppe Spriano
- Department of Otolaryngology ‐ Head & Neck Surgery“Regina Elena” National Cancer Institute Rome Italy
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16
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van der Woerd B, Patel KB, Nichols AC, Fung K, Yoo J, MacNeil SD. Functional outcomes in early (T1/T2) supraglottic cancer: a systematic review. J Otolaryngol Head Neck Surg 2018; 47:76. [PMID: 30563567 PMCID: PMC6299571 DOI: 10.1186/s40463-018-0321-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 11/22/2018] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Organ preserving surgery (OPS) and radiotherapy (RT) are both accepted treatment options for early stage supraglottic cancer (SGC). Radiation has supplanted surgery in most cases, because of the perception that surgery results in poorer functional outcomes. However, evidence suggests that OPS with a neck dissection may be associated with improved survival. Our objective was to conduct a systematic review of the literature to compare functional outcomes of OPS and RT for early SGC. METHODS We searched Medline, EMBASE and Cochrane Central Register of Controlled Trials to identify studies. Studies were included if they reported functional outcomes on 10 or more patients with early stage SGC treated with radiation or OPS, including open partial laryngectomy, transoral laser microsurgery (TLM) or transoral robotic surgery (TORS). Two reviewers independently screened articles for relevance using pre-determined criteria. RESULTS From 7720 references, we included 10 articles (n = 640 patients). 50% (n = 320) of patients were treated with surgery. Three head-to-head RT versus OPS papers were included, however different outcome measures were used for each group. Intractable aspiration management (including total laryngectomy or permanent tracheostomy) following OPS was reported in five papers representing 186 patients; the definitive intractable aspiration management rate was 2.6% (95% CI 1.0-6.8%). Four papers reported permanent G-tube rate for the surgical group (n = 198), calculating a rate of 5.3% (95% CI 2.6-10.5%), this was not reported for the RT group in any papers. One study reported quality of life. Two studies reported objective voice measures. CONCLUSIONS This systematic review revealed a paucity of objective measures and significant data heterogeneity, rendering the comparison of functional outcomes following OPS versus RT for early SGC limited. Future research should include objective measures of functional outcomes including laryngectomy rate, g-tube rate, tracheostomy dependence, quality of life, and voice quality measures.
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Affiliation(s)
- Benjamin van der Woerd
- Department of Otolaryngology, Head & Neck Surgery, Schulich Medicine & Dentistry, Western University, London Health Sciences Centre, Victoria Hospital, London, Ontario, Canada
| | - Krupal B Patel
- Department of Otolaryngology, Head and Neck Surgery, The Ohio State University, Columbus, OH, USA
| | - Anthony C Nichols
- Department of Otolaryngology, Head & Neck Surgery, Schulich Medicine & Dentistry, Western University, London Health Sciences Centre, Victoria Hospital, London, Ontario, Canada
| | - Kevin Fung
- Department of Otolaryngology, Head & Neck Surgery, Schulich Medicine & Dentistry, Western University, London Health Sciences Centre, Victoria Hospital, London, Ontario, Canada
| | - John Yoo
- Department of Otolaryngology, Head & Neck Surgery, Schulich Medicine & Dentistry, Western University, London Health Sciences Centre, Victoria Hospital, London, Ontario, Canada
| | - S Danielle MacNeil
- Department of Otolaryngology, Head & Neck Surgery, Schulich Medicine & Dentistry, Western University, London Health Sciences Centre, Victoria Hospital, London, Ontario, Canada.
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Deshpande N, Peretti G, Mora F, Guastini L, Lee J, Barresi G, Caldwell DG, Mattos LS. Design and Study of a Next-Generation Computer-Assisted System for Transoral Laser Microsurgery. OTO Open 2018; 2:2473974X18773327. [PMID: 30480214 PMCID: PMC6239143 DOI: 10.1177/2473974x18773327] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 01/30/2018] [Accepted: 04/06/2018] [Indexed: 01/15/2023] Open
Abstract
Objective To present a new computer-assisted system for improved usability, intuitiveness, efficiency, and controllability in transoral laser microsurgery (TLM). Study Design Pilot technology feasibility study. Setting A dedicated room with a simulated TLM surgical setup: surgical microscope, surgical laser system, instruments, ex vivo pig larynxes, and computer-assisted system. Subjects and Methods The computer-assisted laser microsurgery (CALM) system consists of a novel motorized laser micromanipulator and a tablet- and stylus-based control interface. The system setup includes the Leica 2 surgical microscope and the DEKA HiScan Surgical laser system. The system was validated through a first-of-its-kind observational study with 57 international surgeons with varied experience in TLM. The subjects performed real surgical tasks on ex vivo pig larynxes in a simulated TLM scenario. The qualitative aspects were established with a newly devised questionnaire assessing the usability, efficiency, and suitability of the system. Results The surgeons evaluated the CALM system with an average score of 6.29 (out of 7) in ease of use and ease of learning, while an average score of 5.96 was assigned for controllability and safety. A score of 1.51 indicated reduced workload for the subjects. Of 57 subjects, 41 stated that the CALM system allows better surgical quality than the existing TLM systems. Conclusions The CALM system augments the usability, controllability, and efficiency in TLM. It enhances the ergonomics and accuracy beyond the current state of the art, potentially improving the surgical safety and quality. The system offers the intraoperative automated scanning of customized long incisions achieving uniform resections at the surgical site.
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Affiliation(s)
- Nikhil Deshpande
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, Genova, Italy
| | - Giorgio Peretti
- Department of Otorhinolaryngology, Università degli Studi di Genova, Genova, Italy
| | - Francesco Mora
- Department of Otorhinolaryngology, Università degli Studi di Genova, Genova, Italy
| | - Luca Guastini
- Department of Otorhinolaryngology, Università degli Studi di Genova, Genova, Italy
| | - Jinoh Lee
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, Genova, Italy
| | - Giacinto Barresi
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, Genova, Italy
| | - Darwin G Caldwell
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, Genova, Italy
| | - Leonardo S Mattos
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, Genova, Italy
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Chauhan M, Deshpande N, Pacchierotti C, Meli L, Prattichizzo D, Caldwell DG, Mattos LS. A robotic microsurgical forceps for transoral laser microsurgery. Int J Comput Assist Radiol Surg 2018; 14:321-333. [PMID: 30465304 DOI: 10.1007/s11548-018-1887-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 11/06/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE In transoral laser microsurgery (TLM), the close curved cylindrical structure of the laryngeal region offers functional challenges to surgeons who operate on its malignancies with rigid, single degree-of-freedom (DOF) forceps. These challenges include surgeon hand tremors, poor reachability, poor tissue surface perception, and reduced ergonomy in design. The integrated robotic microsurgical forceps presented here is capable of addressing the above challenges through tele-operated tissue manipulation in TLM. METHODS The proposed device is designed in compliance with the spatial constraints in TLM. It incorporates a novel 2-DOF motorized microsurgical forceps end-effector, which is integrated with a commercial 6-DOF serial robotic manipulator. The integrated device is tele-operated through the haptic master interface, Omega.7. The device is augmented with a force sensor to measure tissue gripping force. The device is called RMF-2F, i.e. robotic microsurgical forceps with 2-DOF end-effector and force sensing. RMF-2F is evaluated through validation trials and pick-n-place experiments with subjects. Furthermore, the device is trialled with expert surgeons through preliminary tasks in a simulated surgical scenario. RESULTS RMF-2F shows a motion tracking error of less than 400 μm. User trials demonstrate the device's accuracy in task completion and ease of manoeuvrability using the Omega.7 through improved trajectory following and execution times. The tissue gripping force shows better regulation with haptic feedback (1.624 N) than without haptic feedback (2.116 N). Surgeons positively evaluated the device with appreciation for improved access in the larynx and gripping force feedback. CONCLUSIONS RMF-2F offers an ergonomic and intuitive interface for intraoperative tissue manipulation in TLM. The device performance, usability, and haptic feedback capability were positively evaluated by users as well as expert surgeons. RMF-2F introduces the benefits of robotic teleoperation including, (i) overcoming hand tremors and wrist excursions, (ii) improved reachability and accuracy, and (iii) tissue gripping feedback for safe tissue manipulation.
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Affiliation(s)
- Manish Chauhan
- STORM Lab, School of Electronics and Electrical Engineering, University of Leeds, Leeds, LS2 9JT, UK
| | - Nikhil Deshpande
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, Via Morego 30, 16163, Genoa, Italy.
| | - Claudio Pacchierotti
- Centre National de la Recherche Scientifique (CNRS), Rainbow Team, Irisa and Inria Rennes Bretagne Atlantique, 35000, Rennes, France
| | - Leonardo Meli
- Department of Information Engineering and Mathematics, Università degli Studi di Siena, Via Roma 56, 53100, Siena, Italy
| | - Domenico Prattichizzo
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, Via Morego 30, 16163, Genoa, Italy
- Department of Information Engineering and Mathematics, Università degli Studi di Siena, Via Roma 56, 53100, Siena, Italy
| | - Darwin G Caldwell
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, Via Morego 30, 16163, Genoa, Italy
| | - Leonardo S Mattos
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, Via Morego 30, 16163, Genoa, Italy
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Basov S, Milstein A, Sulimani E, Platkov M, Peretz E, Rattunde M, Wagner J, Netz U, Katzir A, Nisky I. Robot-assisted laser tissue soldering system. BIOMEDICAL OPTICS EXPRESS 2018; 9:5635-5644. [PMID: 30460151 PMCID: PMC6238920 DOI: 10.1364/boe.9.005635] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 09/23/2018] [Accepted: 09/23/2018] [Indexed: 05/30/2023]
Abstract
Fast and reliable incision closure is critical in any surgical intervention. Common solutions are sutures and clips or adhesives, but they all present difficulties. These difficulties are especially pronounced in classical and robot-assisted minimally-invasive interventions. Laser soldering methods present a promising alternative, but their reproducibility is limited. We present a system that combines a previously reported laser soldering system with a robotic system, and demonstrate its feasibility on the incision-closure of ex-vivo mice skins. In this demonstration, we measured tearing forces of ~2.5N, 73% of the tearing force of a mouse skin without an incision. This robot-assisted laser soldering technique has the potential to make laser tissue soldering more reproducible and revolutionize surgical tissue bonding.
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Affiliation(s)
- Svetlana Basov
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv, 6997801, Israel
| | - Amit Milstein
- Department of Biomedical Engineering, Ben-Gurion University of the Negev, Beer-Sheva, 8410501, Israel
| | - Erez Sulimani
- Department of Biomedical Engineering, Ben-Gurion University of the Negev, Beer-Sheva, 8410501, Israel
| | - Max Platkov
- Nuclear Research Center Negev, Beer-Sheva, 84190, Israel
| | - Eli Peretz
- Department of Biomedical Engineering, Ben-Gurion University of the Negev, Beer-Sheva, 8410501, Israel
| | - Marcel Rattunde
- Fraunhofer-Institut für Angewandte Festkörperphysik, Freiburg, Germany
| | - Joachim Wagner
- Fraunhofer-Institut für Angewandte Festkörperphysik, Freiburg, Germany
| | - Uri Netz
- Department of Surgery A, Soroka University Medical Center, Beer-Sheva, 85025, Israel
| | - Abraham Katzir
- School of Physics & Astronomy, Tel Aviv University, Tel Aviv, 6997801, Israel
| | - Ilana Nisky
- Department of Biomedical Engineering, Ben-Gurion University of the Negev, Beer-Sheva, 8410501, Israel
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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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Abstract
In the head and neck region, great potential is seen in robot-assisted surgery (RAS). Mainly in cancer surgery, the use of robotic systems seems to be of interest. Until today, two robotic systems (DaVinci® und FLEX®) have gained approval for clinical use in the head and neck region, and multiple other systems are currently in pre-clinical testing. Although, certain groups of patients may benefit from RAS, no unbiased randomized clinical studies are available. Until today, it was not possible to satisfactorily prove any advantage of RAS as compared to standard procedures. The limited clinical benefit and the additional financial burden seem to be the main reasons, why the comprehensive application of RAS has not been realized so far.This review article describes the large variety of clinical applications for RAS in the head and neck region. In addition, the financial and technical challenges, as well as ongoing developments of RAS are highlighted. Special focus is put on risks associated with RAS and current clinical studies. We believe, that RAS will find its way into clinical routine during the next years. Therefore, medical staff will have to increasingly face the technical, scientific and ethical features of RAS.
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Affiliation(s)
- Patrick J Schuler
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Ulm
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22
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Chiesa Estomba CM, Betances Reinoso FA, Lorenzo Lorenzo AI, Fariña Conde JL, Araujo Nores J, Santidrian Hidalgo C. Functional outcomes of supraglottic squamous cell carcinoma treated by transoral laser microsurgery compared with horizontal supraglottic laryngectomy in patients younger and older than 65 years. ACTA OTORHINOLARYNGOLOGICA ITALICA 2018; 36:450-458. [PMID: 28177327 PMCID: PMC5317123 DOI: 10.14639/0392-100x-864] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 06/19/2016] [Indexed: 11/23/2022]
Abstract
The treatment of supraglottic carcinoma remains a controversial issue. Five accepted surgical and non-surgical oncological treatments have been currently established: standard horizontal supraglottic laryngectomy (HSL), supraglottic CO2 laser microsurgery (TLM), transoral robotic surgery, radiotherapy alone and radiotherapy in combination with chemotherapy. Some studies have shown that complications of head and neck surgeries increase significantly in patients over 65 years compared to younger patients. We designed a retrospective analysis to assess the rate of complications and functional outcomes of patients treated by TLM and HSL in cases of T1-T3 supraglottic squamous cell carcinomas (SCC) in a tertiary University Hospital. Results were compared between patients younger and older than 65 years. We found significant differences in the rate of aspiration pneumonia (p = 0.026), mean time to decannulation (p = 0.001) and mean hospital stay (p = 0.007) in patients treated by TLM, which was higher and longer in the group of patients over 65 years of age. Regarding HPL, we only found significant differences in the mean time to decannulation (p = 0.001), which was longer in the group of patients younger than 65 years. According to our results, TLM or HPL can both be a safe surgical option for patients older than 65 years, but previous evaluation of lung function before surgery is mandatory because of an increased risk of aspiration pneumonia in patients with lung problems, especially when treated by TLM. Concerning functional outcomes in patients older than 65 years, TLM reduces the postoperative rate of tracheostomy, mean time required for decannulation and mean hospital stay compared with HPL. However, no significant difference in the occurrence of aspiration pneumonia, dysphagia or in the mean length of NGT feeding was found.
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Affiliation(s)
- C M Chiesa Estomba
- Otorhinolaryngology, Head & Neck Surgery Department, University Hospital of Vigo, Spain
| | - F A Betances Reinoso
- Otorhinolaryngology, Head & Neck Surgery Department, University Hospital of Vigo, Spain
| | - A I Lorenzo Lorenzo
- Otorhinolaryngology, Head & Neck Surgery Department, University Hospital of Vigo, Spain
| | - J L Fariña Conde
- Otorhinolaryngology, Head & Neck Surgery Department, University Hospital of Vigo, Spain
| | - J Araujo Nores
- Otorhinolaryngology, Head & Neck Surgery Department, University Hospital of Vigo, Spain
| | - C Santidrian Hidalgo
- Otorhinolaryngology, Head & Neck Surgery Department, University Hospital of Vigo, Spain
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Patel KB, Nichols AC, Fung K, Yoo J, MacNeil SD. Treatment of early stage Supraglottic squamous cell carcinoma: meta-analysis comparing primary surgery versus primary radiotherapy. J Otolaryngol Head Neck Surg 2018; 47:19. [PMID: 29506564 PMCID: PMC5839014 DOI: 10.1186/s40463-018-0262-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 01/31/2018] [Indexed: 11/10/2022] Open
Abstract
Objectives For early stage supraglottic squamous cell carcinoma (SCC), single modality treatment either in the form of primary organ preservation surgery alone or radiation alone is recommended. Thus, a definite treatment strategy for early stage supraglottic SCC remains undefined. The primary objective of this study was to conduct a systematic review and meta-analysis comparing the oncologic outcomes of surgery and radiotherapy in early stage (Stage I and II) T1 N0 and T2 N0 supraglottic SCC. Methods Systematic methods were used to identify published and unpublished data. Two reviewers independently screened all titles, abstracts and articles for relevance using predefined criteria. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Results Five studies met the inclusion criteria for disease specific mortality with a total of 2864 pooled patients. 5-year disease specific mortality was lower in the surgery group (ORs 0.43, 95% CI 0.31–0.60). Four studies met the inclusion criteria for 5-year overall mortality with a total of 2790 pooled patients. Five-year overall mortality was lower in surgery group (ORs 0.40, 95% CI 0.29–0.55). Conclusions This is the first study to examine the management of early stage supraglottic SCC using meta-analytic methodology. Our results suggest that primary surgery may result in decreased disease specific and overall mortality compared to primary radiotherapy.
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Affiliation(s)
- Krupal B Patel
- Department of Otolaryngology - Head & Neck Surgery, Schulich Medicine & Dentistry, London Health Sciences Centre, Western University, Victoria Hospital, London, ON, Canada
| | - Anthony C Nichols
- Department of Otolaryngology - Head & Neck Surgery, Schulich Medicine & Dentistry, London Health Sciences Centre, Western University, Victoria Hospital, London, ON, Canada
| | - Kevin Fung
- Department of Otolaryngology - Head & Neck Surgery, Schulich Medicine & Dentistry, London Health Sciences Centre, Western University, Victoria Hospital, London, ON, Canada
| | - John Yoo
- Department of Otolaryngology - Head & Neck Surgery, Schulich Medicine & Dentistry, London Health Sciences Centre, Western University, Victoria Hospital, London, ON, Canada
| | - S Danielle MacNeil
- Department of Otolaryngology - Head & Neck Surgery, Schulich Medicine & Dentistry, London Health Sciences Centre, Western University, Victoria Hospital, London, ON, Canada.
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Schwartz MS, Lekovic GP. Use of a flexible hollow-core carbon dioxide laser for microsurgical resection of vestibular schwannomas. Neurosurg Focus 2018; 44:E6. [DOI: 10.3171/2017.12.focus17592] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe CO2 laser has been used on an intermittent basis in the microsurgical resection of brain tumors for decades. These lasers were typically cumbersome to use due to the need for a large, bulky design since infrared light cannot be transmitted via fiber-optic cables. Development of the OmniGuide cable, which is hollow and lined with an omnidirectional dielectric mirror, has facilitated the reintroduction of the CO2 laser in surgical use in a number of fields. This device allows for handheld use of the CO2 laser in a much more ergonomically favorable configuration, holding promise for microneurosurgical applications. This device was introduced into the authors’ practice for use in the microsurgical resection of skull base tumors, including vestibular schwannomas.METHODSThe authors reviewed the initial 41 vestibular schwannomas that were treated using the OmniGuide CO2 laser during an 8-month period from March 2010 to October 2010. The laser was used for all large tumors, and select medium-sized tumors were treated via both the translabyrinthine and retrosigmoid approaches. The estimated time of tumor resection and estimated blood loss were obtained from operating room records. Data regarding complications, facial nerve and hearing outcomes, and further treatment were collected from hospital and clinic records, MRI reports, and direct review of MR images. Time of resection and blood loss were compared to a control group (n = 18) who underwent surgery just prior to use of the laser.RESULTSA total of 41 patients with vestibular schwannomas were surgically treated. The median estimated time of tumor resection was 150 minutes, and the median estimated blood loss was 300 ml. The only operative complication was 1 CSF leak. Thirty-eight patients had normal facial nerve function at late follow-up. The median MRI follow-up was 52 months, and, during that time, only 1 patient required further treatment for regrowth of a residual tumor.CONCLUSIONSThe OmniGuide CO2 laser is a useful adjunct in the resection of large vestibular schwannomas. This device was used primarily as a cutting tool rather than for tumor vaporization, and it was found to be of most use for very large and/or firm tumors. There were no laser-associated complications, and the results compared favorably to earlier reports of vestibular schwannoma resection.
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Affiliation(s)
- Marc S. Schwartz
- 1Department of Neurosurgery, University of California, San Diego; and
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25
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Abstract
OPINION STATEMENT Given the potential for long-term toxicities from concurrent chemoradiation, there is great interest in surgery as a primary treatment modality for head and neck cancers, particularly in the younger HPV-positive oropharyngeal cancer patient. Transoral robotic surgery (TORS) has proven to be an effective technique to safely treat oropharyngeal and select supraglottic tumors surgically. Sound, traditional surgical principles are employed using improved endoscopic visualization and precise instrumentation to perform oncologic surgery without the morbidity of transmandibular or transcervical approaches. Although level 1 evidence prospective clinical trials are currently underway for TORS, the literature supports its safety and efficacy based on numerous studies. Currently, prospective randomized trials are underway to provide better evidence for or against TORS in oropharyngeal cancer. Patient selection based on comorbidities, anatomy, and available pathological data is critical in choosing patients for TORS.
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Lee GS, Irace A, Rahbar R. The efficacy and safety of the flexible fiber CO2 laser delivery system in the endoscopic management of pediatric airway problems: Our long term experience. Int J Pediatr Otorhinolaryngol 2017; 97:218-222. [PMID: 28483239 DOI: 10.1016/j.ijporl.2017.04.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 04/02/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To report the use of flexible fiber CO2 laser in the endoscopic management of pediatric airway cases. METHODS A retrospective review was conducted of patients who underwent CO2 laser-assisted airway procedures between September 2007 and January 2014 at a tertiary pediatric hospital. RESULTS Sixty-eight patients underwent 80 procedures utilizing flexible fiber CO2 laser. Procedures included supraglottoplasty (n = 32), laryngeal cleft repair (type I [n = 10], type II [n = 7], type III [n = 6]), suprastomal granuloma excision (n = 6), cordotomy (n = 4), laryngeal neurofibroma excision (n = 4), laryngeal granulomatous mass excision (n = 1), subglottic stenosis excision (n = 6), division of glottic web (n = 2), subglottic cyst excision (n = 1), and supraglottic biopsy (n = 1). Ages ranged from 8 days to 21 years (median 11 months). No intraoperative or postoperative complications related to the use of laser were noted. CONCLUSIONS The flexible fiber CO2 laser can be safely and effectively used to address a variety of pediatric airway lesions. Previously, the use of CO2 laser in minimally invasive airway surgery has been limited due to the articulating arm carrier, absence of a hand piece, and the direct line-of sight view required. The fiber allows the cutting beam to be directed at the site of the lesion and bypasses limitations posed by other laser systems.
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Affiliation(s)
- Gi Soo Lee
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Department of Otolaryngology, Harvard Medical School, 25 Shattuck St., Boston, MA 02115, USA.
| | - Alexandra Irace
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Reza Rahbar
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Department of Otolaryngology, Harvard Medical School, 25 Shattuck St., Boston, MA 02115, USA
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Funk E, Goldenberg D, Goyal N. Demonstration of transoral robotic supraglottic laryngectomy and total laryngectomy in cadaveric specimens using the Medrobotics Flex System. Head Neck 2017; 39:1218-1225. [PMID: 28301093 DOI: 10.1002/hed.24746] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 11/19/2016] [Accepted: 01/11/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Current management of laryngeal malignancies is associated with significant morbidity. Application of minimally invasive transoral techniques may reduce the morbidity associated with traditional procedures. The purpose of this study was to present our investigation of the utility of a novel flexible robotic system for transoral supraglottic laryngectomy and total laryngectomy. METHODS Transoral total laryngectomy and transoral supraglottic laryngectomy were performed in cadaveric specimens using the Flex Robotic System (Medrobotics, Raynham, MA). RESULTS All procedures were completed successfully in the cadaveric models. The articulated endoscope allowed for access to the desired surgical site. Flexible instruments enabled an atraumatic approach and allowed for precise surgical technique. CONCLUSION Access to deep anatomic structures remains problematic using current minimally invasive robotic approaches. Improvements in visualization and access to the laryngopharyngeal complex offered by this system may improve surgical applications to the larynx. This study demonstrates the technical feasibility using the Flex Robotic System for transoral robotic supraglottic laryngectomy and total laryngectomy. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1218-1225, 2017.
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Affiliation(s)
- Emily Funk
- The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - David Goldenberg
- Department of Surgery, Division of Otolaryngology - Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Neerav Goyal
- Department of Surgery, Division of Otolaryngology - Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
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Karaman M, Gün T, Temelkuran B, Aynacı E, Kaya C, Tekin AM. Comparison of fiber delivered CO 2 laser and electrocautery in transoral robot assisted tongue base surgery. Eur Arch Otorhinolaryngol 2017; 274:2273-2279. [PMID: 28190091 DOI: 10.1007/s00405-017-4449-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 01/03/2017] [Indexed: 11/26/2022]
Abstract
To compare intra-operative and post-operative effectiveness of fiber delivered CO2 laser to monopolar electrocautery in robot assisted tongue base surgery. Prospective non-randomized clinical study. Twenty moderate to severe obstructive sleep apnea (OSA) patients, non-compliant with Continuous Positive Airway Pressure (CPAP), underwent Transoral Robotic Surgery (TORS) using the Da Vinci surgical robot in our University Hospital. OSA was treated with monopolar electrocautery in 10 patients, and with flexible CO2 laser fiber in another 10 patients. The following parameters in the two sets are analyzed: Intraoperative bleeding that required cauterization, robot operating time, need for tracheotomy, postoperative self-limiting bleeding, length of hospitalization, duration until start of oral intake, pre-operative and post-operative minimum arterial oxygen saturation, pre-operative and post-operative Epworth Sleepiness Scale score, postoperative airway complication and postoperative pain. Mean follow-up was 12 months. None of the patients required tracheotomy and there were no intraoperative complications related to the use of the robot or the CO2 laser. The use of CO2 laser in TORS-assisted tongue base surgery resulted in less intraoperative bleeding that required cauterization, shorter robot operating time, shorter length of hospitalization, shorter duration until start of oral intake and less postoperative pain, when compared to electrocautery. Postoperative apnea-hypopnea index scores showed better efficacy of CO2 laser than electrocautery. Comparison of postoperative airway complication rates and Epworth sleepiness scale scores were found to be statistically insignificant between the two groups. The use of CO2 laser in robot assisted tongue base surgery has various intraoperative and post-operative advantages when compared to monopolar electrocautery.
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Affiliation(s)
- Murat Karaman
- Department of otorhinolaryngology, Istanbul Medipol University, Istanbul, Turkey.
| | - Taylan Gün
- Department of otorhinolaryngology, Bahçeşehir University, Istanbul, Turkey
| | - Burak Temelkuran
- OmniGuide Surgical, London, UK
- OmniGuide Surgical, Lexington, MA, USA
| | - Engin Aynacı
- Department of pulmonology, Istanbul Medipol University, Istanbul, Turkey
| | - Cem Kaya
- Department of anesthesiology, Istanbul Medipol University, Istanbul, Turkey
| | - Ahmet Mahmut Tekin
- Department of otorhinolaryngology, Istanbul Medipol University, Istanbul, Turkey
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Abstract
In this chapter, we discuss implications of tumor site and tumor microenvironment properties of human papilloma virus (HPV)-associated cancer formation with special emphasis on the therapeutic modality of transoral robotic surgery (TORS). Over the past years, the development of robotic systems has improved, and therefore, its use in the surgical treatment of HNSCC has become a relevant treatment modality for many patients. Yet, there are limitations. Especially for endolaryngeal TORS procedures, additional technical development is mandatory, particularly with respect to visualization and manipulation. The Flex System has provided new additions that need to be further evaluated. TORS systems are going to improve technical issues and therefore reduce patient morbidity, surgical handling and treatment costs. The developed systems have to be tested and evaluated in prospective trials in order to be able to identify benefits and disadvantages in patient care. With respect to HPV-related OPSCC, TORS has become a valuable surgical alternative for an increasing number of patients.
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Affiliation(s)
- S Lang
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
| | - S Mattheis
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - B Kansy
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany
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Howard J, Masterson L, Dwivedi RC, Riffat F, Benson R, Jefferies S, Jani P, Tysome JR, Nutting C. Minimally invasive surgery versus radiotherapy/chemoradiotherapy for small-volume primary oropharyngeal carcinoma. Cochrane Database Syst Rev 2016; 12:CD010963. [PMID: 27943254 PMCID: PMC6463943 DOI: 10.1002/14651858.cd010963.pub2] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND More than 400,000 cases of oropharyngeal squamous cell carcinoma (OPSCC) are diagnosed each year worldwide and the incidence is rising, partly as a result of human papillomavirus. Human papillomavirus-associated OPSCC affects younger patients and often presents at a higher stage; however, it is associated with a better prognosis.Until recently, first-line management of OPSCC involved chemoradiotherapy, as research had demonstrated comparable survival outcomes when compared with open surgery, with significantly decreased morbidity. However, interventions have now evolved with computerised planning and intensity-modulated radiotherapy, and the advent of endoscopic head and neck surgery, which provide the potential for decreased treatment-associated morbidity.The oropharynx plays an essential role in swallowing, speech and protecting the airway as it is situated at the bifurcation of the respiratory and digestive tracts. Treatment modality recommendations are based on survival outcomes. Given the younger patient demographic, establishing the safety of modalities that potentially have better functional outcome is becoming increasingly important. OBJECTIVES To assess the efficacy of endoscopic head and neck surgery (transoral robotic surgery or transoral laser microsurgery) for small-volume, primary (T1-2, N0-2) oropharyngeal squamous cell carcinoma (OPSCC) in comparison to radiotherapy/chemoradiotherapy. SEARCH METHODS The Cochrane ENT Information Specialist searched the ENT Trials Register; Central Register of Controlled Trials (CENTRAL 2016, Issue 10); PubMed; EMBASE; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 8 November 2016. SELECTION CRITERIA Randomised controlled trials in patients with carcinoma in the oropharynx subsite (as defined by the World Health Organization classification C09, C10). Cancers included were primary squamous cell carcinomas arising from the oropharyngeal mucosa. The tumours were classified as T1-T2 with or without nodal disease and with no evidence of distant metastatic spread. The intervention was transoral, minimally invasive surgery with or without adjuvant radiotherapy or adjuvant chemoradiotherapy. The comparator was primary radiotherapy with or without induction or concurrent chemotherapy for the tumour. The treatments received and compared were of curative intent and patients had not undergone prior intervention, other than diagnostic biopsy. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. Our primary outcomes were overall survival (disease-related mortality was to be studied where possible), locoregional control, disease-free survival and progression-free survival or time to recurrence. All outcomes were to be measured at two, three and five years after diagnosis. Our secondary outcomes included quality of life, harms associated with treatment, patient satisfaction and xerostomia score. MAIN RESULTS No completed studies met the inclusion criteria for the review. Two ongoing trials fulfilled the selection criteria, however neither are complete.'Early-stage squamous cell carcinoma of the oropharynx: radiotherapy versus trans-oral robotic surgery (ORATOR)' is a phase II randomised controlled trial comparing primary radiation therapy with primary transoral robotic surgery for small-volume primary (T1-2, N0-2) OPSCC. It is currently in progress with an estimated completion date of June 2021.'European Organisation for Research and Treatment of Cancer 1420 (EORTC 1420-HNCG-ROG)' is a phase III, randomised study assessing the "best of" radiotherapy compared to transoral robotic surgery/transoral laser microsurgery in patients with T1-T2, N0 squamous cell carcinoma of the oropharynx and base of tongue. It was due to start accrual mid-2016. AUTHORS' CONCLUSIONS The role of endoscopic head and neck surgery in the management of OPSCC is clearly expanding as evidenced by its more overt incorporation into the current National Comprehensive Cancer Network guidelines. Data are mounting regarding its outcomes both in terms of survival and lower morbidity. As confidence increases, it is being used in the management of more advanced OPSCC.Based on this review, there is currently no high-quality evidence from randomised controlled trials regarding clinical outcomes for patients with oropharyngeal cancer receiving endoscopic head and neck surgery compared with primary chemoradiotherapy.
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Affiliation(s)
- James Howard
- Cambridge University Hospitals NHS Foundation TrustENT DepartmentHills RoadCambridgeUKCB2 0QQ
| | - Liam Masterson
- Cambridge University Hospitals NHS Foundation TrustENT DepartmentHills RoadCambridgeUKCB2 0QQ
| | - Raghav C Dwivedi
- Cambridge University Hospitals NHS Foundation TrustENT DepartmentHills RoadCambridgeUKCB2 0QQ
| | | | - Richard Benson
- Addenbrooke's HospitalOncology CentreBox 193CambridgeUKCB2 2QQ
| | - Sarah Jefferies
- Cambridge University Hospitals NHS Foundation TrustCambridgeUK
| | - Piyush Jani
- Cambridge University Hospitals NHS Foundation TrustENT DepartmentHills RoadCambridgeUKCB2 0QQ
| | - James R Tysome
- Cambridge University Hospitals NHS Foundation TrustCambridgeUK
| | - Chris Nutting
- Royal Marsden HospitalHead and Neck UnitFulham RoadLondonUKSW3 6JJ
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Dutta SR, Passi D, Sharma S, Singh P. Transoral robotic surgery: A contemporary cure for future maxillofacial surgery. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY MEDICINE AND PATHOLOGY 2016. [DOI: 10.1016/j.ajoms.2016.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Lim GC, Holsinger FC, Li RJ. Transoral Endoscopic Head and Neck Surgery: The Contemporary Treatment of Head and Neck Cancer. Hematol Oncol Clin North Am 2015; 29:1075-92. [PMID: 26568549 DOI: 10.1016/j.hoc.2015.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Traditional open surgical approaches are indicated for treatment of select tumor subsites of head and neck cancer, but can also result in major cosmetic and functional morbidity. Transoral surgical approaches have been used for head and neck cancer since the 1960s, with their application continuing to evolve with the changing landscape of this disease and recent innovations in surgical instrumentation. The potential to further reduce treatment morbidity with transoral surgery, while optimizing oncologic outcomes, continues to be investigated. This review examines current literature evaluating oncologic and quality-of-life outcomes achieved through transoral head and neck surgery.
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Affiliation(s)
- Gil Chai Lim
- Department of Otolaryngology-Head and Neck Surgery, Jeju National University School of Medicine, 102 Jejudaehak-ro, Jeju Special Self-Governing Province 63243, Republic of Korea
| | - Floyd Christopher Holsinger
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, 875 Blake Wilbur Drive, Palo Alto, CA 94305-5820, USA
| | - Ryan J Li
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, 875 Blake Wilbur Drive, Palo Alto, CA 94305-5820, USA.
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Gun R, Ozer E. Surgical anatomy of oropharynx and supraglottic larynx for transoral robotic surgery. J Surg Oncol 2015; 112:690-6. [DOI: 10.1002/jso.24020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 08/07/2015] [Indexed: 11/12/2022]
Affiliation(s)
- Ramazan Gun
- Department of Otolaryngology-Head and Neck Surgery; Wexner Medical Center at the Ohio State University; Columbus Ohio
- Department of Otolaryngology-Head and Neck Surgery; School of Medicine; Dicle University; Diyarbakir Turkey
| | - Enver Ozer
- Department of Otolaryngology-Head and Neck Surgery; Wexner Medical Center at the Ohio State University; Columbus Ohio
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Flexible Carbon Dioxide Laser Fiber Versus Ultrasonic Scalpel in Robot-Assisted Laparoscopic Myomectomy. J Minim Invasive Gynecol 2015; 22:1183-90. [DOI: 10.1016/j.jmig.2015.06.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 06/05/2015] [Accepted: 06/06/2015] [Indexed: 12/31/2022]
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Mattheis S, Kansy B, Haßkamp P, Holtmann L, Lang S. Fortschritte in der transoralen roboterassistierten Chirurgie. HNO 2015; 63:752-7. [DOI: 10.1007/s00106-015-0073-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Holsinger FC, Ferris RL. Transoral Endoscopic Head and Neck Surgery and Its Role Within the Multidisciplinary Treatment Paradigm of Oropharynx Cancer: Robotics, Lasers, and Clinical Trials. J Clin Oncol 2015; 33:3285-92. [PMID: 26351337 DOI: 10.1200/jco.2015.62.3157] [Citation(s) in RCA: 122] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Transoral endoscopic head and neck surgery is a new approach for the treatment of oropharyngeal tumors. Using either a robotic system and/or laser, surgeons gain access through the mouth via minimally invasive technique and thus have improved visualization of the tumors of the oropharynx, without disfiguring incisions. This transoral route of access minimizes long-term speech and swallowing dysfunction. Surgeons view this approach as a considerable technologic advance, analogous to the evolution in radiation therapy from conventional two- and three-dimensional conformal techniques to intensity-modulated techniques. Although the use of radiation with or without chemotherapy to treat oropharyngeal cancer (OPC) is supported by evidence from prospective clinical trials, there are no prospective data supporting the use of this new surgical approach for OPC. Here, we review the fundamentals of transoral endoscopic head and neck surgery, with robotics and laser technology, and discuss ongoing clinical trials for patients with OPC.
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Affiliation(s)
- F Christopher Holsinger
- F. Christopher Holsinger, Stanford University, Palo Alto, CA; and Robert L. Ferris, University of Pittsburgh, Pittsburgh, PA.
| | - Robert L Ferris
- F. Christopher Holsinger, Stanford University, Palo Alto, CA; and Robert L. Ferris, University of Pittsburgh, Pittsburgh, PA
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Dziegielewski PT, Kang SY, Ozer E. Transoral robotic surgery (TORS) for laryngeal and hypopharyngeal cancers. J Surg Oncol 2015; 112:702-6. [PMID: 26266762 DOI: 10.1002/jso.24002] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 07/22/2015] [Indexed: 11/11/2022]
Abstract
Transoral robotic surgery (TORS) is increasingly used in laryngeal/hypopharyngeal cancer surgery. Ablative procedures described in these anatomical sites include: (i) supraglottic laryngectomy, (ii) total laryngectomy, (iii) glottic cordectomy, and (iv) partial pharyngectomy. TORS supraglottic laryngectomy remains the most commonly performed of these procedures. Initial oncologic and functional outcomes with these procedures are promising and comparable to other treatment options. As robotic instrumentation technology advances a rise in TORS laryngeal/hypopharyngeal surgery is anticipated.
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Affiliation(s)
| | - Stephen Y Kang
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.,Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio
| | - Enver Ozer
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.,Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio
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Kucur C, Durmus K, Dziegielewski PT, Ozer E. Transoral robot-assisted carbon dioxide laser surgery for hypopharyngeal cancer. Head Neck 2015; 37:743-5. [DOI: 10.1002/hed.23860] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 04/07/2014] [Accepted: 09/12/2014] [Indexed: 11/10/2022] Open
Affiliation(s)
- Cuneyt Kucur
- Department of Otolaryngology - Head and Neck Surgery; Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Comprehensive Cancer Center, The Ohio State University Wexner Medical Center; Columbus Ohio
- Department of Otolaryngology; Dumlupinar University; Kutahya Turkey
| | - Kasim Durmus
- Department of Otolaryngology - Head and Neck Surgery; Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Comprehensive Cancer Center, The Ohio State University Wexner Medical Center; Columbus Ohio
| | - Peter T. Dziegielewski
- Department of Otolaryngology - Head and Neck Surgery; Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Comprehensive Cancer Center, The Ohio State University Wexner Medical Center; Columbus Ohio
- Department of Otolaryngology; University of Florida; Gainesville Florida
| | - Enver Ozer
- Department of Otolaryngology - Head and Neck Surgery; Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Comprehensive Cancer Center, The Ohio State University Wexner Medical Center; Columbus Ohio
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Buckmire RA, Wong YT, Deal AM. The application of robotics to microlaryngeal laser surgery. Laryngoscope 2015; 125:1393-400. [DOI: 10.1002/lary.25134] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Robert A. Buckmire
- Department of Otolaryngology-Head & Neck Surgery; University of North Carolina Hospitals; Chapel Hill North Carolina U.S.A
| | - Yu-Tung Wong
- Division of Otolaryngology-Head & Neck Surgery; University of California San Diego School of Medicine; San Diego California U.S.A
| | - Allison M. Deal
- and the Lineberger Comprehensive Cancer Center Biostatistics Core; University of North Carolina Hospitals; Chapel Hill North Carolina U.S.A
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Abstract
PURPOSE OF REVIEW Treatment of laryngeal carcinoma continues to evolve, and whereas there was a transition from total laryngectomy to chemoradiation in response to the Veterans Affairs study and Radiation Therapy Oncology Group (RTOG) 91-11, recent data suggest the role of partial laryngectomy must be revisited. RECENT FINDINGS Recent data have shown that laryngeal preservation does not equate with laryngeal function. Data are accumulating in support of operative management of advanced laryngeal carcinoma away from chemoradiation for select patients. In particular, supracricoid laryngectomy may be a viable option for intermediate and selected advanced laryngeal carcinoma while maintaining laryngeal function. SUMMARY The evolution of treatment for advanced laryngeal carcinoma is focusing treatment on maintaining locoregional control while also maintaining a functional larynx.
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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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Mattos LS, Deshpande N, Barresi G, Guastini L, Peretti G. A novel computerized surgeon-machine interface for robot-assisted laser phonomicrosurgery. Laryngoscope 2014; 124:1887-94. [DOI: 10.1002/lary.24566] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 11/25/2013] [Accepted: 12/12/2013] [Indexed: 11/07/2022]
Affiliation(s)
- Leonardo S. Mattos
- Department of Advanced Robotics; Istituto Italiano di Tecnologia; Genoa Italy
| | - Nikhil Deshpande
- Department of Advanced Robotics; Istituto Italiano di Tecnologia; Genoa Italy
| | - Giacinto Barresi
- Department of Advanced Robotics; Istituto Italiano di Tecnologia; Genoa Italy
| | - Luca Guastini
- Department of Otorhinolaryngology; University of Genoa; Genoa Italy
| | - Giorgio Peretti
- Department of Otorhinolaryngology; University of Genoa; Genoa Italy
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Van Abel KM, Moore EJ. The rise of transoral robotic surgery in the head and neck: emerging applications. Expert Rev Anticancer Ther 2014; 12:373-80. [DOI: 10.1586/era.12.7] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Ansarin M, Zorzi S, Massaro MA, Tagliabue M, Proh M, Giugliano G, Calabrese L, Chiesa F. Transoral robotic surgery vs transoral laser microsurgery for resection of supraglottic cancer: a pilot surgery. Int J Med Robot 2013; 10:107-12. [PMID: 24288345 DOI: 10.1002/rcs.1546] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 09/13/2013] [Accepted: 09/19/2013] [Indexed: 11/09/2022]
Abstract
BACKGROUND Transoral laser microsurgery (TLM) is a mature approach to supraglottic cancer, while transoral robotic surgery (TORS) is emerging. The present study compared these approaches. METHODS The first 10 patients (2002-2005) given TLM were compared with the first 10 (2007-2011) given TORS for cT1-3 cN0-cN2c supraglottic cancer. RESULTS A feeding tube was used in four TLM and seven TORS patients. Margins were more often positive, but operating times shorter, in TORS. All 10 TORS patients are without evidence of disease, but only six TLM patients remain disease-free after much longer follow-up. TORS was considerably less uncomfortable and fatiguing for the surgeon. CONCLUSIONS TORS seems as safe and effective as TLM. Shorter TORS operating times are probably attributable to prior experience with TLM. For laryngeal exposure, length of tube placement and margin evaluability, TLM was superior; however, this may change as TORS develops and transoral robotic instruments are optimized.
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Affiliation(s)
- Mohssen Ansarin
- Division of Head and Neck Surgery, European Institute of Oncology, Milan, Italy
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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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Dagnino G, Mattos LS, Caldwell DG. New software tools for enhanced precision in robot-assisted laser phonomicrosurgery. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2013; 2012:2804-7. [PMID: 23366508 DOI: 10.1109/embc.2012.6346547] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
This paper describes a new software package created to enhance precision during robot-assisted laser phonomicrosurgery procedures. The new software is composed of three tools for camera calibration, automatic tumor segmentation, and laser tracking. These were designed and developed to improve the outcome of this demanding microsurgical technique, and were tested herein to produce quantitative performance data. The experimental setup was based on the motorized laser micromanipulator created by Istituto Italiano di Tecnologia and the experimental protocols followed are fully described in this paper. The results show the new tools are robust and effective: The camera calibration tool reduced residual errors (RMSE) to 0.009 ± 0.002 mm under 40× microscope magnification; the automatic tumor segmentation tool resulted in deep lesion segmentations comparable to manual segmentations (RMSE= 0.160 ± 0.028 mm under 40× magnification); and the laser tracker tool proved to be reliable even during cutting procedures (RMSE= 0.073 ± 0.023 mm under 40× magnification). These results demonstrate the new software package can provide excellent improvements to the previous microsurgical system, leading to important enhancements in surgical outcome.
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Affiliation(s)
- Giulio Dagnino
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, Via Morego 30, 16163 Genova, Italy.
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