1
|
A prospective longitudinal study of quality of life in robotic-assisted salvage surgery for oropharyngeal cancer. Eur J Surg Oncol 2022; 48:1243-1250. [DOI: 10.1016/j.ejso.2022.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/08/2022] [Accepted: 01/18/2022] [Indexed: 11/12/2022] Open
|
2
|
Bunch PM, Patwa HS, Hughes RT, Porosnicu M, Waltonen JD. Patient Selection for Transoral Robotic Surgery (TORS) in Oropharyngeal Squamous Cell Carcinoma: What the Surgeon Wants to Know. Top Magn Reson Imaging 2021; 30:117-130. [PMID: 33828063 DOI: 10.1097/rmr.0000000000000269] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
ABSTRACT Transoral robotic surgery (TORS) is an excellent treatment strategy for well-selected patients with oropharyngeal squamous cell carcinoma. Potential benefits of TORS are greatest among patients for whom surgical resection will reduce or eliminate the need for adjuvant therapy. Proper patient selection largely depends on imaging, which is used to determine tumor resectability, to inform expected morbidity and functional outcome, to assess the potential need for adjuvant therapy, to evaluate for vascular or other anatomic contraindications, and to gauge adequacy of transoral access to the tumor. This article provides the radiologist with a practical and accessible approach to interpreting preoperative imaging among patients with oropharyngeal cancer, emphasizing what the surgeon wants to know to inform the determination of whether the patient is a TORS candidate and why this information is important. By accurately reporting this information, the radiologist facilitates the multidisciplinary care team's selection of a treatment regimen optimized for the circumstances of the individual patient.
Collapse
Affiliation(s)
- Paul M Bunch
- Department of Radiology Wake Forest School of Medicine, Medical Center Boulevard, Winston Salem, NC
| | - Hafiz S Patwa
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest School of Medicine, Winston Salem, NC
| | - Ryan T Hughes
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston Salem, NC
| | - Mercedes Porosnicu
- Department of Hematology and Oncology, Wake Forest School of Medicine, Winston Salem, NC
| | - Joshua D Waltonen
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest School of Medicine, Winston Salem, NC
| |
Collapse
|
3
|
Is the Da Vinci Xi system a real improvement for oncologic transoral robotic surgery? A systematic review of the literature. J Robot Surg 2020; 15:1-12. [PMID: 32749569 DOI: 10.1007/s11701-020-01132-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/26/2020] [Indexed: 12/26/2022]
Abstract
In this paper, we reviewed the current literature about TORS procedures performed with Xi system and we discussed the pros and cons of this robotic system comparing it to the previous Si model. A systematic literature review was conducted using the PubMed, Scopus, Web of Science and Cochrane databases for adequate published studies about TORS procedure performed with da Vinci Si and Xi models. Five papers on the TORS-Xi procedures met our inclusion and exclusion criteria. These papers showed results based on 74 subjects (mean age 60.51 ± 4.55 years old). The most common TORS procedure was performed to address the oropharynx (65 procedures). One case (1.35%) of a tongue base tumor was converted into a transmandibular approach. One subject (1.35%) had a positive margin, while two subjects (2.7%) had close/uncertain margins at final histology. Nine papers on the TORS-Si procedures met our inclusion and exclusion criteria. These papers showed results based on 128 subjects (mean age 59.79 ± 5.93 years old). The most common TORS procedure was performed to address the oropharynx (90 procedures). Three procedures (2.34%) were aborted due to inadequate exposure of the tumor. None of the subject had positive margins, while three subjects (2.34%) had close/uncertain margins at final histology. Despite its improved vision, easier docking and narrower robotic arms, the da Vinci Xi system has structural peculiarities that limit its applications for certain TORS procedures.
Collapse
|
4
|
Parhar HS, Brody RM, Shimunov D, Rajasekaran K, Rassekh CH, Basu D, O'Malley BW, Chalian AA, Newman JG, Loevner L, Lazor JW, Weinstein GS, Cannady SB. Retropharyngeal Internal Carotid Artery Management in TORS Using Microvascular Reconstruction. Laryngoscope 2020; 131:E821-E827. [PMID: 32621638 DOI: 10.1002/lary.28876] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/16/2020] [Accepted: 05/27/2020] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Guidelines for transoral robotic surgery (TORS) have generally regarded patients with retropharyngeal carotid arteries as contraindicated for surgery due to a theoretical risk of intraoperative vascular injury and/or perioperative cerebrovascular accident. We aimed to demonstrate that careful TORS-assisted resection and free flap coverage could not only avoid intraoperative injury and provide a physical barrier for vessel coverage but also achieve adequate margin control. STUDY DESIGN Retrospective cohort analysis. METHODS Retrospective review of patients with oropharyngeal malignancies and radiologically confirmed retropharyngeal carotid arteries who underwent TORS, concurrent neck dissection, and free flap reconstruction between 2015 and 2019. RESULTS Twenty patients were included, 19 (95.0%) with tonsillar tumors and one (5.0%) with a tongue base tumor with significant tonsillar extension. Eighteen patients (90.0%) received a radial artery forearm flap, one (5.0%) an ulnar artery forearm flap, and one (5.0%) an anteromedial thigh flap. All 20 (100%) flaps were inset through combined transcervical and transoral approaches without mandibulotomy. There were no perioperative mortalities, carotid injuries, oropharyngeal bleeds, cervical hematomas, or cerebrovascular accidents. One patient (5.0%) had a free flap failure requiring explant. All patients underwent decannulation and resumed a full oral diet. The mean length of hospitalization was 6.8 (standard deviation 1.2) days. One (5.0%) patient had a positive margin. CONCLUSION In this analysis, 20 patients with oropharyngeal malignancy and retropharyngeal carotid arteries underwent TORS, neck dissection, and microvascular reconstruction without serious complication (perioperative mortality, vascular injury, or neurologic sequalae) with an acceptable negative margin rate. These results may lead to a reconsideration of a commonly held contraindication to TORS. LEVEL OF EVIDENCE 3 Laryngoscope, 131:E821-E827, 2021.
Collapse
Affiliation(s)
- Harman S Parhar
- Department of Otorhinolaryngology - Head & Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Robert M Brody
- Department of Otorhinolaryngology - Head & Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - David Shimunov
- Department of Otorhinolaryngology - Head & Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology - Head & Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Christopher H Rassekh
- Department of Otorhinolaryngology - Head & Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Devraj Basu
- Department of Otorhinolaryngology - Head & Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Bert W O'Malley
- Department of Otorhinolaryngology - Head & Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Ara A Chalian
- Department of Otorhinolaryngology - Head & Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Jason G Newman
- Department of Otorhinolaryngology - Head & Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Laurie Loevner
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Jillian W Lazor
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Gregory S Weinstein
- Department of Otorhinolaryngology - Head & Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Steven B Cannady
- Department of Otorhinolaryngology - Head & Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| |
Collapse
|
5
|
Gorphe P, Stein H, Moya-Plana A. Cervical-transoral robotic nasopharyngectomy: A preclinical study. Head Neck 2019; 42:394-400. [PMID: 31750609 DOI: 10.1002/hed.26013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/17/2019] [Accepted: 10/30/2019] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND We performed a preclinical study to assess the feasibility of the cervical-transoral robotic pharyngectomy procedure in surgery for nasopharyngeal cancer, where deep margins and vascular safety are key issues. MATERIALS AND METHODS Four cadaveric dissections were performed with the da Vinci Xi system. The first step was a robotic parapharyngeal dissection along the internal carotid artery (ICA). The second step was a type 3 transoral robotic nasopharyngectomy. RESULTS In each procedure, a comprehensive dissection of the parapharyngeal space was performed along the ICA up to the foramen lacerum. A type 3 nasopharyngectomy was performed transorally with an "en-bloc" removal of the parapharyngeal space, and with complete removal of the eustachian tube up to its bony part. CONCLUSION A comprehensive cervical-transoral robotic type 3 nasopharyngectomy with "en-bloc" removal of the parapharyngeal space and the eustachian tube proved to be technically feasible in a preclinical study.
Collapse
Affiliation(s)
- Philippe Gorphe
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France
| | - Hubert Stein
- Department of Global Clinical Development, Intuitive Surgical Inc., Sunnyvale, California
| | - Antoine Moya-Plana
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France
| |
Collapse
|
6
|
Turner MT, Persky MJ, Moskovitz JM, Kim S. Salvage Transoral Robotic Surgery: A Case of a Nearly Missed Carotid Injury. EAR, NOSE & THROAT JOURNAL 2019; 100:9-11. [PMID: 31547706 PMCID: PMC7470716 DOI: 10.1177/0145561319876241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Meghan T Turner
- Department of Otolaryngology-Head and Neck Surgery, 53422West Virginia University Health Sciences Center, Morgantown, WV, USA
| | - Michael J Persky
- Department of Otolaryngology-Head and Neck Surgery, 12297New York University Langone Medical Center, New York, NY, USA
| | - Jessica M Moskovitz
- Department of Otolaryngology-Head and Neck Surgery, 6595University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Seungwon Kim
- Department of Otolaryngology-Head and Neck Surgery, 6595University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| |
Collapse
|
7
|
Kwan BY, Khan NM, Almeida JR, Goldstein D, Paleri V, Forghani R, Yu E. Transoral robotic surgery for head and neck malignancies: Imaging features in presurgical workup. Head Neck 2019; 41:4018-4025. [DOI: 10.1002/hed.25887] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 07/01/2019] [Accepted: 07/11/2019] [Indexed: 12/14/2022] Open
Affiliation(s)
- Benjamin Y.M. Kwan
- Department of RadiologyQueen's University Kingston Ontario Canada
- Princess Margaret Cancer CenterUniversity of Toronto Toronto Ontario Canada
| | | | - John R. Almeida
- Princess Margaret Cancer CenterUniversity of Toronto Toronto Ontario Canada
| | - David Goldstein
- Princess Margaret Cancer CenterUniversity of Toronto Toronto Ontario Canada
| | - Vinidh Paleri
- Head and Neck UnitRoyal Marsden NHS Hospital London UK
| | - Reza Forghani
- Department of RadiologyMcGill University Montreal Quebec Canada
| | - Eugene Yu
- Princess Margaret Cancer CenterUniversity of Toronto Toronto Ontario Canada
| |
Collapse
|
8
|
Review of the main surgical and angiographic-oriented classifications of the course of the internal carotid artery through a novel interactive 3D model. Neurosurg Rev 2018; 43:473-482. [PMID: 30051302 DOI: 10.1007/s10143-018-1012-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 05/31/2018] [Accepted: 07/10/2018] [Indexed: 12/24/2022]
Abstract
The course of the internal carotid artery (ICA) and its segment classifications were reviewed by means of a new and freely available 3D interactive model of the artery and the skull base, based on human neuroimages, that can be freely downloaded at the Public Repository of the University of Barcelona (http://diposit.ub.edu/dspace/handle/2445/112442) and runs under Acrobat Reader in Mac and Windows computers and Windows 10 tablets. The 3D-PDF allows zoom, rotation, selective visualization of structures, and a predefined sequence view. Illustrative images of the different classifications were obtained. Fischer (Zentralbl Neurochir 3:300-313, 1938) described five segments in the opposite direction to the blood flow. Gibo-Rothon (J Neurosurg 55:560-574, 1981) follow the blood flow, incorporated the cervical and petrous portions, and divided the subarachnoid course-supraclinoid-in ophthalmic, communicating, and choroidal segments, enhancing transcranial microscopic approaches. Bouthillier (Neurosurgery 38:425-433, 1996) divided the petrous portion describing the lacerum segment (exposed in transfacial procedures and exploration of Meckel's cave) and added the clinoid segment between the proximal and distal dural rings, of interest in cavernous sinus surgery. The Kassam's group (2014), with an endoscopic endonasal perspective, introduces the "paraclival segment," including the "lacerum segment" and part of the intracavernous ICA, and details surgical landmarks to minimize the risk of injury. Other classifications are also analyzed. This review through an interactive 3D tool provides virtual views of the ICA and becomes an innovative perspective to the segment classifications and neuroanatomy of the ICA and surrounding structures.
Collapse
|