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Ran Y, Zheng X, Li P, Zhang Y, Xu T, Wei T. Bibliometric insights in advances of endoscopic thyroidectomy: research status, hotspots, and global trends. Gland Surg 2023; 12:1554-1566. [PMID: 38107494 PMCID: PMC10721553 DOI: 10.21037/gs-23-198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 10/26/2023] [Indexed: 12/19/2023]
Abstract
Background Endoscopic thyroidectomy (ET) has witnessed significant advancements over the last three decades. Various surgical methods and approaches have been developed that minimize trauma, enhance aesthetics, and reduce psychological stress caused by scars. Papillary thyroid carcinoma is the main reason for thyroidectomy and ET represents an innovative technique for treating thyroid cancer. In this study, nearly three decades of scientific articles were analyzed and summarized to gain a better understanding by using bibliometric method. Methods A total of 486 publications between 1996 and 2023 were retrieved from the Web of Science database through systematic searches. The objective of this study involved characterizing general information and investigating developmental trends and research frontiers. CiteSpace was employed to evaluate and visualize the results. Results The query resulted 486 publications with a total citation frequency of 10,202. The top five countries in terms of the number of published articles were China, South Korea, the USA, Italy, and Japan. The top five countries in terms of literature centrality were Scotland, Israel, Brazil, the USA, and France. There were eight institutions with more than ten publications. The top ten institutions had a centrality score of 0.02 or above, indicating intensive research in this area and substantial collaboration among institutions. The most cited authors primarily originated from South Korea. Journals such as Surgical Endoscopy and Other Interventional Techniques, Surgical Laparoscopy Endoscopy & Percutaneous Techniques, Head and Neck Journal for the Sciences and Specialties of the Head and Neck, and Thyroid exerted considerable influence in this field. Keyword analysis results revealed that research predominantly focused on thyroid cancer and surgical approaches. Conclusions This bibliometric study provides a comprehensive analysis of global productivity, collaboration, and research focus in the field of ET. The findings of this study serve as valuable guidance for future research in ET.
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Affiliation(s)
- Yanhao Ran
- Division of Thyroid Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xun Zheng
- Division of Thyroid Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Pengyu Li
- Division of Thyroid Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yujie Zhang
- Division of Thyroid Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Tianfeng Xu
- Division of Thyroid Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Tao Wei
- Division of Thyroid Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
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Won J, Hong JW, Kim MJ, Yun IS, Baek WY, Lee WJ, Lew DH, Koh YW, Kim SH. Methodology in Conventional Head and Neck Reconstruction Following Robotic Cancer Surgery: A Bridgehead Robotic Head and Neck Reconstruction. Yonsei Med J 2022; 63:759-766. [PMID: 35914758 PMCID: PMC9344269 DOI: 10.3349/ymj.2022.63.8.759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/20/2022] [Accepted: 04/28/2022] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Robotic head and neck surgery is widespread nowadays. However, in the reconstruction field, the use of robotic operations is not. This article aimed to examine methodologies for conventional head and neck reconstruction after robotic tumor surgery in an effort to obtain further options for future reconstruction manipulations. MATERIALS AND METHODS A retrospective review of all patients who received head and neck robot surgery and conventional reconstructive surgery between October 2016 and September 2021. RESULTS In total, 53 cases were performed. 67.9% of the tumors were greater than 4 cm. Regarding defect size, 47.2% of the lesions were greater than 8 cm. In terms of TNM stage, stage 3 disease was recorded in 26.4% and stage 4 in 52.8%. To make a deep and narrow field wider, we changed the patient's posture in pre-op field, additional dissection was done. We used radial forearm flap mostly (62.2%). CONCLUSION Conventional head and neck reconstruction after robotic ENT cancer surgery is possible. One key step is to secure additional space in the deep and narrow space left after robotic surgery. For this, we opted for a radial forearm flap mostly. This can be performed as a bridgehead to perform robotic head and neck reconstruction.
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Affiliation(s)
- Jongmin Won
- Department of Plastic and Reconstructive Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Won Hong
- Department of Plastic and Reconstructive Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
| | - Mi Jung Kim
- Department of Plastic and Reconstructive Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - In-Sik Yun
- Department of Plastic and Reconstructive Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Woo Yeol Baek
- Department of Plastic and Reconstructive Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Won Jai Lee
- Department of Plastic and Reconstructive Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dae Hyun Lew
- Department of Plastic and Reconstructive Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Woo Koh
- Department of Otorhinolaryngology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Se-Heon Kim
- Department of Otorhinolaryngology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Shauly O, Stone GL, Shin R, Grant Stevens W, Gould DJ. Evaluating Facelift Complications and the Effectiveness of the SMASectomy Technique: A Single Center's 15-Year Experience. Aesthet Surg J Open Forum 2021; 3:ojab030. [PMID: 34617012 PMCID: PMC8489308 DOI: 10.1093/asjof/ojab030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Facelift continues to be one of the most common aesthetic procedures performed in the United States. Although there exist many techniques and variations, superficial musculoaponeurotic system (SMAS) manipulation, by way of plication, overlap, or SMASectomy, is common and has been shown to result in favorable cosmesis and durability. However, there is a lack of current complications data in the discussion of this technique. OBJECTIVES To assess the benefits and risks of the SMASectomy technique. METHODS The records of all patients who underwent a facelift procedure between December 2004 and March 2019 were reviewed for this study. All procedures were performed at an American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF)-accredited outpatient facility in Marina Del Rey, California. This represents data on 241 total patients. Retrospective chart review was performed to include data on patient characteristics, operative technique, and complications. RESULTS Average operative time of 152.68 ± 51.50 minutes and anesthesia time of 175.00 ± 54.07 minutes were observed among those patients who underwent SMASectomy. This was significantly lower (P < 0.000001) than those who did not undergo SMASectomy (average operative time of 265.25 ± 85.25 minutes and anesthesia time of 294.22 ± 85.31 minutes). There were no observed facial nerve injuries among patients who underwent SMASectomy. No deep vein thrombosis (DVT) events were observed in this patient population. CONCLUSIONS In the hands of an experienced surgeon, the SMASectomy facelift technique offers the unique advantage of significantly reducing operating time and anesthesia time and can provide extremely favorable and long-lasting aesthetic results. LEVEL OF EVIDENCE 3
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Affiliation(s)
| | | | | | | | - Daniel J Gould
- Corresponding Author: Dr Daniel J. Gould, 1510 San Pablo Street, Suite 415, Los Angeles, CA, 90033, USA. E-mail: ; Twitter: @Danjgould
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Postauricular facelift robotic surgery of a second cleft branchial cyst. Eur Ann Otorhinolaryngol Head Neck Dis 2021; 138 Suppl 2:67-68. [PMID: 34167921 DOI: 10.1016/j.anorl.2021.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 05/27/2021] [Accepted: 06/07/2021] [Indexed: 11/22/2022]
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Abstract
Robot-assisted surgery (RAS) has already been approved for several clinical applications in head and neck surgery. In some Anglo-American regions, RAS is currently the common standard for treatment of oropharyngeal diseases. Systematic randomized studies comparing established surgical procedures with RAS in a large number of patients are unavailable so far. Experimental publications rather describe how to reach poorly accessible anatomical regions using RAS, or represent feasibility studies on the use of transoral robotic surgery (TORS) in established surgical operations. With general application of RAS in clinical practice, the question of financial reimbursement arises. Furthermore, the technical applications currently on the market still require some specific improvements for routine use in head and neck surgery.
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Transoral endoscopic thyroidectomy using the vestibular approach with an endoscopic retractor in thyroid cancer: experience with the first 132 patients. Surg Endosc 2020; 34:5414-5420. [DOI: 10.1007/s00464-019-07336-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 12/24/2019] [Indexed: 12/23/2022]
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Persky MJ, Issa M, Bonfili JR, Goyal N, Goldenberg D, Duvvuri U. Transoral surgery using the Flex Robotic System: Initial experience in the United States. Head Neck 2018; 40:2482-2486. [PMID: 30303588 DOI: 10.1002/hed.25375] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 04/17/2018] [Accepted: 05/22/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND This multicenter, retrospective review documents the initial experience using the Flex system for transoral surgery in 2 United States academic centers. METHODS All patients who underwent transoral robotic surgery using the Medrobotics Flex Robotic System (Raynham, MA) between September 2015 and May 2017 were reviewed. Rates of successful surgery and complications were evaluated. RESULTS Thirty-six men and 32 women were enrolled in the study. The average age was 55.6 years (range 17-82 years). The Flex system was used successfully in surgery of the tongue base, the palatine tonsils, the supraglottis, the glottis, the hypopharynx, the oral tongue, and the soft palate. Only 6 cases (7.6%) required readmission after discharge. There were no intraoperative or immediate postoperative complications, with no cases of intraoperative hemorrhage. CONCLUSION To the best of our knowledge, this is the first study in the United States evaluating the use of the Flex system to safely resect lesions in the oral cavity, larynx, and pharynx.
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Affiliation(s)
- Michael J Persky
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Department of Otolaryngology - Head and Neck Surgery, New York University School of Medicine, New York, New York
| | - Mohamad Issa
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jennifer R Bonfili
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Neerav Goyal
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania
| | - David Goldenberg
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania
| | - Umamaheswar Duvvuri
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Jung SW, Kim YK, Cha YH, Koh YW, Nam W. Robot-assisted submandibular gland excision via modified facelift incision. Maxillofac Plast Reconstr Surg 2017; 39:25. [PMID: 28944219 PMCID: PMC5583136 DOI: 10.1186/s40902-017-0122-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 07/12/2017] [Indexed: 11/25/2022] Open
Abstract
Background The conventional transcervical resection for submandibular gland disease has some risks and an unsatisfactory cosmetic result. Recently, robot-assisted surgery has been developed as a plausible substitute for conventional surgery which provides an excellent cosmetic outcome. Case presentation The authors performed robot-assisted sialadenectomy via modified facelift incision using the da Vinci Xi surgical system (Intuitive Surgical Inc., CA, USA) with two endowrist arms (monopolar curved scissors and Maryland bipolar forceps) successfully in a 44-year-old female patient who suffered from sialolith and severe atrophic submandibular gland. Conclusions If similar studies are done in the future, this robot-assisted sialadenectomy may become established as an alternative to existing disadvantageous surgical methods.
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Affiliation(s)
- Seung Wook Jung
- Department of Oral and Maxillofacial Surgery, Yonsei University, College of Dentistry, Seoul, Korea
| | - Young Kwan Kim
- Department of Oral and Maxillofacial Surgery, Yonsei University, College of Dentistry, Seoul, Korea
| | - Yong Hoon Cha
- Department of Oral and Maxillofacial Surgery, Yonsei University, College of Dentistry, Seoul, Korea
| | - Yoon Woo Koh
- Department of Otorhinolaryngology, Yonsei University, College of Medicine, Seoul, Korea
| | - Woong Nam
- Department of Oral and Maxillofacial Surgery, Yonsei University, College of Dentistry, Seoul, Korea
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Yoo MH, Lee HS, Yang CJ, Lee SH, Lim H, Lee S, Yi BJ, Chung JW. A cadaver study of mastoidectomy using an image-guided human-robot collaborative control system. Laryngoscope Investig Otolaryngol 2017; 2:208-214. [PMID: 29094065 PMCID: PMC5655553 DOI: 10.1002/lio2.111] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 07/09/2017] [Accepted: 08/16/2017] [Indexed: 11/21/2022] Open
Abstract
Objective Surgical precision would be better achieved with the development of an anatomical monitoring and controlling robot system than by traditional surgery techniques alone. We evaluated the feasibility of robot‐assisted mastoidectomy in terms of duration, precision, and safety. Study Design Human cadaveric study. Materials and Methods We developed a multi‐degree‐of‐freedom robot system for a surgical drill with a balancing arm. The drill system is manipulated by the surgeon, the motion of the drill burr is monitored by the image‐guided system, and the brake is controlled by the robotic system. The system also includes an alarm as well as the brake to help avoid unexpected damage to vital structures. Experimental mastoidectomy was performed in 11 temporal bones of six cadavers. Parameters including duration and safety were assessed, as well as intraoperative damage, which was judged via pre‐ and post‐operative computed tomography. Results The duration of mastoidectomy in our study was comparable with that required for chronic otitis media patients. Although minor damage, such as dura exposure without tearing, was noted, no critical damage to the facial nerve or other important structures was observed. When the brake system was set to 1 mm from the facial nerve, the postoperative average bone thicknesses of the facial nerve was 1.39, 1.41, 1.22, 1.41, and 1.55 mm in the lateral, posterior pyramidal and anterior, lateral, and posterior mastoid portions, respectively. Conclusion Mastoidectomy can be successfully performed using our robot‐assisted system while maintaining a pre‐set limit of 1 mm in most cases. This system may thus be useful for more inexperienced surgeons. Level of Evidence NA.
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Affiliation(s)
- Myung Hoon Yoo
- Department of Otorhinolaryngology-Head and Neck Surgery School of Medicine, Kyungpook National University Daegu Republic of Korea
| | - Hwan Seo Lee
- Department of Otorhinolaryngology-Head & Neck Surgery Asan Medical Center, University of Ulsan, College of Medicine Seoul Republic of Korea
| | - Chan Joo Yang
- Department of Otorhinolaryngology-Head & Neck Surgery Asan Medical Center, University of Ulsan, College of Medicine Seoul Republic of Korea
| | - Seung Hwan Lee
- Department of Otorhinolaryngology School of Medicine, Hanyang University Seoul Republic of Korea
| | - Hoon Lim
- Department of Electronic Systems Engineering Hanyang University Ansan Republic of Korea
| | - Seongpung Lee
- Department of Robotics Engineering DGIST Daegu Republic of Korea
| | - Byung-Ju Yi
- Department of Electronic Systems Engineering Hanyang University Ansan Republic of Korea
| | - Jong Woo Chung
- Department of Otorhinolaryngology-Head & Neck Surgery Asan Medical Center, University of Ulsan, College of Medicine Seoul Republic of Korea
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Schoppy DW, Kupferman ME, Hessel AC, Bell DM, Garland EM, Damrose EJ, Holsinger FC. Transoral endoscopic head and neck surgery (eHNS) for minor salivary gland tumors of the oropharynx. CANCERS OF THE HEAD & NECK 2017; 2:5. [PMID: 31093352 PMCID: PMC6460795 DOI: 10.1186/s41199-017-0024-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 05/11/2017] [Indexed: 01/16/2023]
Abstract
Background Transoral endoscopic head and neck surgery (eHNS), including transoral laser microsurgery (TLM) and transoral robotic surgery (TORS), provides access to subsites in the head and neck that have traditionally been difficult to approach. Minor salivary gland tumors, while relatively uncommon, are frequently malignant and can occur at sites in the oropharynx accessible by transoral eHNS. Presented here is the largest review to date of patients with minor salivary gland tumors of the oropharynx managed with transoral eHNS as primary or salvage therapy. Methods A retrospective chart review was performed, including data from 20 patients with minor salivary gland tumors of the oropharynx managed with transoral eHNS at 2 tertiary, academic medical centers. Details of tumor pathology, margin analysis, adjuvant therapy, and an assessment of oncologic outcome were included. Results The base of tongue was the most common tumor site (75%). Adenoid cystic carcinoma (ACC) accounted for most cases (35%), and negative margins were obtained in most (95%) through an endoscopic-only approach. Overall, 50% of patients received post-operative radiation therapy. Postoperative complications were limited, with one patient (5%) returning to the OR for control of post-operative oropharyngeal bleeding. On average follow-up of 36 months, 90% of patients were alive with no evidence of recurrence. Conclusion In this experience, transoral eHNS provided a safe and consistent surgical approach to management of minor salivary gland malignancies, with low complication rates and good locoregional control. Thus, transoral eHNS may play a valuable role in the multi-disciplinary management of these malignancies. Trial registration number None/not applicable Electronic supplementary material The online version of this article (doi:10.1186/s41199-017-0024-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- David W Schoppy
- 1Division of Head and Neck Surgery, Department of Otolaryngology, Stanford Cancer Center, Stanford University School of Medicine, 875 Blake Wilbur Drive, CC-2227, Palo Alto, CA 94304 USA
| | - Michael E Kupferman
- 2Department of Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX USA
| | - Amy C Hessel
- 2Department of Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX USA
| | - Diana M Bell
- 2Department of Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX USA
| | - Elizabeth M Garland
- 2Department of Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX USA
| | - Edward J Damrose
- 1Division of Head and Neck Surgery, Department of Otolaryngology, Stanford Cancer Center, Stanford University School of Medicine, 875 Blake Wilbur Drive, CC-2227, Palo Alto, CA 94304 USA
| | - F Christopher Holsinger
- 1Division of Head and Neck Surgery, Department of Otolaryngology, Stanford Cancer Center, Stanford University School of Medicine, 875 Blake Wilbur Drive, CC-2227, Palo Alto, CA 94304 USA
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11
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Improved Glottic Exposure for Robotic Microlaryngeal Surgery: A Case Series. J Voice 2017; 31:628-633. [PMID: 28318968 DOI: 10.1016/j.jvoice.2017.01.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 01/24/2017] [Accepted: 01/26/2017] [Indexed: 11/23/2022]
Abstract
Robotic surgery has become the standard of care for many procedures outside of otolaryngology and now is gaining momentum within our specialty. The da Vinci (Intuitive Surgical, Sunnyvale, CA) robot has several advantages to human hands, including removal of tremor and better access to lesions because of increased degree of movement of the articulated instruments. The glottis has rarely been addressed using robotic surgery because access was previously thought to be difficult because of the limitations of currently used retractors, which include poor base of tongue and oral commissure retraction resulting in lack of exposure of the glottis in many patients and lack of space for the robotic instruments to occupy. We present a case series using the Modular Oral Retractor (MOR) system to show that the glottic larynx can be accessed by the da Vinci instrumentation. The MOR system provides better exposure of the anterior commissure and by using oral commissure retraction provides excellent space for the robotic arms to work. The MOR system potentially makes robotic microlaryngeal surgery more feasible for the otolaryngology-head and neck surgeon.
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Friedrich DT, Scheithauer MO, Greve J, Rotter N, Doescher J, Hoffmann TK, Schuler PJ. Application of a computer-assisted flexible endoscope system for transoral surgery of the hypopharynx and upper esophagus. Eur Arch Otorhinolaryngol 2017; 274:2287-2293. [DOI: 10.1007/s00405-017-4498-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 02/04/2017] [Indexed: 12/21/2022]
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13
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Transoral Robotic Surgery. AORN J 2017; 105:73-84. [DOI: 10.1016/j.aorn.2016.11.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 02/17/2016] [Accepted: 11/08/2016] [Indexed: 11/22/2022]
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15
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Newsome H, Mandapathil M, Koh YW, Duvvuri U. Utility of the Highly Articulated Flex Robotic System for Head and Neck Procedures: A Cadaveric Study. Ann Otol Rhinol Laryngol 2016; 125:758-63. [PMID: 27287677 DOI: 10.1177/0003489416653409] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Robotic head and neck surgery potentially reduces the morbidity associated with traditional open procedures. This study's goal was to employ a novel highly articulated robotic system (Flex Robotic System) for head and neck procedures, including a postauricular facelift approach thyroidectomy, submandibular gland (SMG) removal, and cervical lymphadenectomy. STUDY DESIGN It was hypothesized that the Medrobotics Flex Robotic System could be used for transcervical head and neck surgical procedures. METHODS Three fresh upper body human cadavers were used. The Flex Robotic System was used to complete a thyroidectomy, neck dissection, and SMG removal on each cadaver. RESULTS A postauricular incision and flap was manually raised. The robotic system was positioned on the right side of the cadaver's head. The system's manually controlled flexible instruments and highly shapeable, robot-assisted scope were used to perform a thyroid lobectomy. Neck dissection and SMG removal were also performed. CONCLUSIONS Although a promising technology, the current robotic system (Intuitive Surgical Inc, Sunnyvale, California, USA) has limitations due to its rigid and large configuration, which decreases exposure and access. The new system's shapeable, computer-assisted scope seeks to reduce some of these difficulties and may be better adapted for transcervical approaches to the neck operations.
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Affiliation(s)
- Hillary Newsome
- Veterans Affairs Pittsburgh Health System, UPMC Department of Otolaryngology/Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Magis Mandapathil
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Marburg, Baldingerstrasse, Marburg, Germany
| | - Yoon Woo Koh
- Yonsei University Severance Hospital, Department of Otorhinolaryngology Seodaemun-gu, Seoul, Republic of Korea
| | - Umamaheswar Duvvuri
- Veterans Affairs Pittsburgh Health System, UPMC Department of Otolaryngology/Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Schuler PJ, Hoffmann TK, Veit JA, Rotter N, Friedrich DT, Greve J, Scheithauer MO. Hybrid procedure for total laryngectomy with a flexible robot-assisted surgical system. Int J Med Robot 2016; 13. [PMID: 27196407 DOI: 10.1002/rcs.1749] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 03/11/2016] [Accepted: 04/14/2016] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Total laryngectomy is a standard procedure in head-and-neck surgery for the treatment of cancer patients. Recent clinical experiences have indicated a clinical benefit for patients undergoing transoral robot-assisted total laryngectomy (TORS-TL) with commercially available systems. Here, a new hybrid procedure for total laryngectomy is presented. METHODS TORS-TL was performed in human cadavers (n = 3) using a transoral-transcervical hybrid procedure. The transoral approach was performed with a robotic flexible robot-assisted surgical system (Flex®) and compatible flexible instruments. Transoral access and visualization of anatomical landmarks were studied in detail. RESULTS Total laryngectomy is feasible with a combined transoral-transcervical approach using the flexible robot-assisted surgical system. Transoral visualization of all anatomical structures is sufficient. The flexible design of the robot is advantageous for transoral surgery of the laryngeal structures. CONCLUSION Transoral robot assisted surgery has the potential to reduce morbidity, hospital time and fistula rates in a selected group of patients. Initial clinical studies and further development of supplemental tools are in progress. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Patrick J Schuler
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ulm University Medical Center, Germany
| | - Thomas K Hoffmann
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ulm University Medical Center, Germany
| | - Johannes A Veit
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ulm University Medical Center, Germany
| | - Nicole Rotter
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ulm University Medical Center, Germany
| | - Daniel T Friedrich
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ulm University Medical Center, Germany
| | - Jens Greve
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ulm University Medical Center, Germany
| | - Marc O Scheithauer
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ulm University Medical Center, Germany
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Friedrich DT, Scheithauer MO, Greve J, Hoffmann TK, Schuler PJ. Recent advances in robot-assisted head and neck surgery. Int J Med Robot 2016; 13. [DOI: 10.1002/rcs.1744] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 01/12/2016] [Accepted: 02/08/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Daniel T. Friedrich
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery; Ulm University Medical Center; Germany
| | - Marc O. Scheithauer
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery; Ulm University Medical Center; Germany
| | - Jens Greve
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery; Ulm University Medical Center; Germany
| | - Thomas K. Hoffmann
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery; Ulm University Medical Center; Germany
| | - Patrick J. Schuler
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery; Ulm University Medical Center; Germany
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Rodney JP, Vasan NR. Robotic microlaryngeal surgery: a new retractor that provides improved access to the glottis. SPRINGERPLUS 2016; 5:188. [PMID: 27026884 PMCID: PMC4769245 DOI: 10.1186/s40064-016-1788-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 02/12/2016] [Indexed: 11/11/2022]
Abstract
Robotic surgery has become the standard of care for many procedures outside of otolaryngology, and now is gaining momentum within our specialty. The robot has several advantages to human hands, including removal of tremor and better access to lesions due to increased degree of movement of the articulated instruments. The glottis has rarely been addressed using robotics because access was previously thought to be difficult. We present a case report using the modular oral retractor system to perform robotic microlaryngeal surgery.
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Affiliation(s)
- Jennifer P Rodney
- Department of Otorhinolaryngology, The University of Oklahoma Health Sciences Center, PO Box 26901, Oklahoma, OK 73126-0901 USA
| | - Nilesh R Vasan
- Department of Otorhinolaryngology, The University of Oklahoma Health Sciences Center, PO Box 26901, Oklahoma, OK 73126-0901 USA
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Helman SN, Schwedhelm T, Kadakia S, Wang Y, Schiff BA, Smith RV. Transoral Robotic Surgery in Oropharyngeal Carcinoma. Arch Pathol Lab Med 2015; 139:1389-97. [DOI: 10.5858/arpa.2014-0573-ra] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context
The incidence of oropharyngeal squamous cell carcinoma has increased during the past decade and is related primarily to the human papillomavirus. This change in etiology, from tobacco and alcohol to human papillomavirus, has resulted in improved survival for the disease. In the United States, open resection had largely been replaced by concurrent chemotherapy and/or radiotherapy by the early 2000s. The advent of transoral surgery has led to an increase in surgery as the primary treatment for both early- and advanced-stage oropharyngeal squamous cell carcinoma because it has potential advantages over open surgery and nonsurgical modalities.
Objective
To provide an overview of transoral robotic surgery for oropharyngeal squamous cell carcinoma and contrast it with other surgical and nonsurgical modalities.
Data Sources
Articles from 2000 to 2014 were accessioned on PubMed and reviewed for utility by the primary authors.
Conclusions
Transoral surgery has become more commonly used as a minimally invasive approach to treat oropharyngeal tumors. Other strategies, including radiation, chemotherapy with radiation, and open surgery, are still important treatment approaches. The treatment options for an individual patient rely on multiple factors, including the tumor location and size, features of the tumor, and patient comorbidities. The continued study of these techniques is important to match the patient with the most appropriate treatment.
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Affiliation(s)
| | | | | | | | | | - Richard V. Smith
- From the Department of Otolaryngology/Head and Neck Surgery, New York Eye and Ear Infirmary–Mount Sinai Health System, New York, New York (Drs Helman and Kadakia); Albert Einstein College of Medicine, Bronx, New York (Mr Schwedhelm); and the Departments of Pathology (Dr Wang) and Otorhinolaryngology–Head and Neck Surgery (Drs Schiff and Smith), Montefiore Medical Center, Albert Einstein College o
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Schuler PJ, Hoffmann TK, Duvvuri U, Rotter N, Greve J, Scheithauer MO. Demonstration of nasopharyngeal surgery with a single port operator-controlled flexible endoscope system. Head Neck 2015; 38:370-4. [DOI: 10.1002/hed.23910] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2014] [Indexed: 11/05/2022] Open
Affiliation(s)
| | | | - Uma Duvvuri
- University of Pittsburgh Medical Center; Department of Otolaryngology; Pittsburgh Pennsylvania
| | - Nicole Rotter
- Department of Otorhinolaryngology; University of Ulm; Ulm Germany
| | - Jens Greve
- Department of Otorhinolaryngology; University of Ulm; Ulm Germany
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Friedrich DT, Scheithauer MO, Greve J, Duvvuri U, Sommer F, Hoffmann TK, Schuler PJ. Potential Advantages of a Single-Port, Operator-Controlled Flexible Endoscope System for Transoral Surgery of the Larynx. Ann Otol Rhinol Laryngol 2015; 124:655-62. [DOI: 10.1177/0003489415575548] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: Transoral surgery of the larynx is commonly performed with a rigid laryngoscope, a microscope, and a laser. We investigated the potential utility of a flexible, single-port, robot-assisted and physician-controlled endoscopic system to enable easy, transoral surgical access to the larynx. Methods: Transoral laryngeal surgery was performed in human cadavers (n = 4) using the Flex System and compatible flexible instruments. Anatomical landmarks were identified, and mock surgical procedures were performed. Results: Standard laryngeal surgical procedures were completed successfully in a human cadaver model. The built-in HD digital camera enabled high-quality visualization of the larynx. Epiglottectomy, as well as posterior cordectomy, were performed by laser and radio-frequency resection. The flexible design of the compatible tools enabled a nontraumatic approach. Conclusion: The Flex System has the potential to improve surgical access to the larynx, especially in patients with challenging anatomy. The associated flexible instruments enabled completion of surgical procedures in the larynx in a human cadaveric model. Further clinical studies, as well as the development of supplemental technology and tools, are recommended for future clinical applications.
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Affiliation(s)
- Daniel T. Friedrich
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
| | - Marc O. Scheithauer
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
| | - Jens Greve
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
| | - Uma Duvvuri
- University of Pittsburgh Medical Center, Department of Otolaryngology, Pittsburgh, PA, USA
| | - Fabian Sommer
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
| | - Thomas K. Hoffmann
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
| | - Patrick J. Schuler
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
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Schuler PJ, Duvvuri U, Friedrich DT, Rotter N, Scheithauer MO, Hoffmann TK. First use of a computer-assisted operator-controlled flexible endoscope for transoral surgery. Laryngoscope 2014; 125:645-8. [PMID: 25291212 DOI: 10.1002/lary.24957] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/08/2014] [Accepted: 09/16/2014] [Indexed: 11/11/2022]
Abstract
Transoral robotic surgery (TORS) has become an accepted treatment option for head and neck cancer. However, anatomical limitations and a relevant financial burden require alternative developments in this field. To this end, a patient presenting with a T2 squamous cell carcinoma of the lower lateral oropharyngeal wall was effectively treated with a new Conformité Européene-certified, computer-assisted, operator-controlled flexible endoscope (Flex). Intraoperative visualization and tissue handling were acceptable and safe. Transoral surgery with the flexible endoscope was safely conducted in a clinical setting. The introduction of alternative TORS systems will increase competition, drive scientific improvement, and reduce financial expenses.
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