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Mella MH, Chabrillac E, Dupret-Bories A, Mirallie M, Vergez S. Transoral Robotic Surgery for Head and Neck Cancer: Advances and Residual Knowledge Gaps. J Clin Med 2023; 12:jcm12062303. [PMID: 36983308 PMCID: PMC10056198 DOI: 10.3390/jcm12062303] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 03/11/2023] [Accepted: 03/14/2023] [Indexed: 03/17/2023] Open
Abstract
Minimally invasive surgery is a growing field in surgical oncology. After acquiring its first Food and Drug Administration approval in 2009 for T1–T2 malignancies of the oral cavity, oropharynx, and larynx, transoral robotic surgery (TORS) has gained popularity thanks to its wristed instruments and magnified three-dimensional view, enhancing surgical comfort in remote-access areas. Its indications are expanding in the treatment of head and neck cancer, i.e., resection of tumors of the larynx, hypopharynx, or parapharyngeal space. However, this expansion must remain cautious and based on high-level evidence, in order to guarantee safety and oncological outcomes which are comparable to conventional approaches. This narrative review assesses the current role of TORS in head and neck cancer from an evidence-based perspective, and then identifies what knowledge gaps remain to be addressed.
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Affiliation(s)
- Mariam H. Mella
- Department of Otolaryngology, Head and Neck Surgery, Toulouse University Hospital—Larrey Hospital, 24 Chemin de Pouvourville, CEDEX 9, 31059 Toulouse, France
| | - Emilien Chabrillac
- Department of Surgery, University Cancer Institute of Toulouse—Oncopole, 31100 Toulouse, France
| | - Agnès Dupret-Bories
- Department of Otolaryngology, Head and Neck Surgery, Toulouse University Hospital—Larrey Hospital, 24 Chemin de Pouvourville, CEDEX 9, 31059 Toulouse, France
- Department of Surgery, University Cancer Institute of Toulouse—Oncopole, 31100 Toulouse, France
| | - Mathilde Mirallie
- Department of Otolaryngology, Head and Neck Surgery, Toulouse University Hospital—Larrey Hospital, 24 Chemin de Pouvourville, CEDEX 9, 31059 Toulouse, France
- Department of Surgery, University Cancer Institute of Toulouse—Oncopole, 31100 Toulouse, France
| | - Sébastien Vergez
- Department of Otolaryngology, Head and Neck Surgery, Toulouse University Hospital—Larrey Hospital, 24 Chemin de Pouvourville, CEDEX 9, 31059 Toulouse, France
- Department of Surgery, University Cancer Institute of Toulouse—Oncopole, 31100 Toulouse, France
- Correspondence: ; Tel.: +33-5-67-77-17-32
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Riva G, Lorenzi A, Borello A, Albera A, Canale A, Pecorari G. Transoral Approach to Parotid Tumors: A Review of the Literature. Curr Oncol 2022; 29:9416-9427. [PMID: 36547154 PMCID: PMC9776422 DOI: 10.3390/curroncol29120740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/21/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022] Open
Abstract
Different surgical techniques have been proposed for parapharyngeal space tumors, including transcervical, transparotid, trans-mandibular, infratemporal, and transoral. The choice of the correct approach depends on the size, localization and nature of the tumor. The transoral approach can be used for benign prestyloid masses, such as tumors of the deep lobe of the parotid gland. It guarantees a short hospitalization without skin scars. The narrowed access represents the main limitation of this technique. This review will summarize and analyze the current knowledge about the transoral approach to parotid lesions. Thirty-seven studies were included in a qualitative and quantitative synthesis. The novelty of this review is the quantitative analyses of the clinical data reported in the included studies.
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Paleri V, Hardman J, Brady G, George A, Kerawala C. Transoral Robotic Surgery for Residual and Recurrent Oropharyngeal Cancers. Otolaryngol Clin North Am 2021; 53:1091-1108. [PMID: 33127041 DOI: 10.1016/j.otc.2020.07.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Transoral robotic surgery (TORS) is a well-established treatment option for treatment-naïve oropharyngeal cancer. For residual, recurrent, and new primary oropharyngeal tumors emerging in previously irradiated fields, the global experience of management with TORS is limited. This article discusses current concepts on this topic, offers a deeper insight into the transoral anatomy for these cases, and covers the specific complexities of resections in the various subsites of the oropharynx. It provides practical tips on reconstruction, recovery, and rehabilitation as well as offering a synthesis of the current evidence and exploring future trends.
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Affiliation(s)
- Vinidh Paleri
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK; The Institute of Cancer Research, Brompton Road, London SW3 6JJ, UK.
| | - John Hardman
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK; North London, UK
| | - Grainne Brady
- Department of Speech, Language and Swallowing, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK
| | - Ajith George
- University Hospitals North Midlands, North Staffordshire, England; Keele University Medical School, Staffordshire, UK
| | - Cyrus Kerawala
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK; University of Winchester, Winchester, UK
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Dias FL. Advances in anatomical visualization on the head and neck through robotic surgery: A Brazilian perspective. Anat Rec (Hoboken) 2021; 304:1224-1234. [PMID: 33729715 DOI: 10.1002/ar.24613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 02/05/2021] [Accepted: 02/10/2021] [Indexed: 01/14/2023]
Abstract
Trans Oral Robotic Surgery (TORS) is an emerging technique that provides several benefits over existing treatment regimens for head and neck cancer, including smaller incisions, less bleeding, shorter term inpatient hospitalization, and reduced intensive care unit (ICU) length of stay. TORS allows a high resolution, magnified, three-dimensional wide view of the surgical field through an endoscope, avoiding large external cervical incisions and split-lip mandibulotomy, usually required in cancer surgeries of the oropharynx. The anatomy of the Oropharynx viewed from the perspective of the robotic surgeon is different from the anatomy taught in medical schools and residence/fellowship programs, which is more directly related to emergency procedures, open field surgery, and imaging exams. Developing an understanding of the anatomic relationships and landmarks from the "inside out" perspective is critical for any surgeon willing to perform surgical procedures through a transoral robotic approach. Here we address the major anatomic landmarks and structures in head and neck robotic surgeries and advantages and disadvantages of this approach. We emphasize the importance of imaging for successful outcomes, pointing out important anatomic landmarks considered as blind spots for surgeons in clinical and endoscopic evaluations. We also describe the Brazilian current scenario and future perspectives of Robotic Surgery in terms of training and access to this technique, including institutions that currently offer this service in the different regions of Brazil.
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Affiliation(s)
- Fernando L Dias
- Brazilian National Cancer Institute, Department of Head and Neck Surgery, Post Graduate School of Medicine, Catholic University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
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Aishwarya J, Shah AS, Nair S, Kumar S, Kumar S, Brijith K, Srivastava N, Ibrahim A. Safe surgical zone during TORS radical tonsillectomy: An anatomical and radiological study. LAPAROSCOPIC, ENDOSCOPIC AND ROBOTIC SURGERY 2020. [DOI: 10.1016/j.lers.2020.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Mudry A. From the stylet of the temple to the tongue in so-called Riolan's bouquet. Eur Ann Otorhinolaryngol Head Neck Dis 2020; 137:347-348. [PMID: 32192900 DOI: 10.1016/j.anorl.2020.01.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 01/09/2020] [Indexed: 11/18/2022]
Abstract
The styloglossus muscle is a key landmark for staging and surgery of certain squamous cell cancers of the oropharynx. The purpose of this historical note is to try to determine when the styloglossus muscle was described for the first time, and to understand its integration into the so-called Riolan's bouquet.
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Affiliation(s)
- A Mudry
- Department of Otolaryngology, Head & Neck Surgery, Stanford University School of Medicine, avenue de la Gare 6 CH-1003 Lausanne, Switzerland.
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Transoral Robotic Surgery (TORS)—Inside Out Anatomy and Exposure of the Operating Field. CURRENT OTORHINOLARYNGOLOGY REPORTS 2019. [DOI: 10.1007/s40136-019-00257-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Shenouda K, Rubin F, Garcia D, Badoual C, Bonfils P, Laccourreye O. Evaluation of robotic surgery for transoral resection of T1-2 squamous cell carcinoma of the tonsillar fossa. Eur Ann Otorhinolaryngol Head Neck Dis 2019; 137:31-36. [PMID: 31561975 DOI: 10.1016/j.anorl.2019.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
GOAL To evaluate transoral robotic surgery (TORS) for isolated previously untreated squamous cell carcinoma (SCC) of the tonsillar fossa classified as T1-2. METHOD Retrospective analysis of two cohorts of isolated untreated T1-2 tonsillar fossa SCC consecutively operated on by a transoral approach, with (R=21) and without (NR=24) robotic assistance, in the period 2006-2014. Three main (survival, local control, and operative morbidity) and three secondary (pathologic data, incidence and duration of tracheotomy and nasogastric intubation, and hospital stay) endpoints were compared between groups. The significance threshold was set at P< .005. RESULTS Three- and five-year actuarial survival estimates were 80.2% and 74.5% respectively in group R, and 91.5% and 82.5% respectively in group NR (NS: P=.34). Three- and five-year actuarial local control estimates were 90% and 90% respectively in group R, and 95.8% and 91% respectively in group NR (NS: P=.81). There were no significant differences in morbidity, tracheotomy/nasogastric intubation time, or hospital stay. Positive resection margins (R1) were noted in 38.1% and 16.7% in groups R and NR, respectively (NS: P=.05) without significant impact on 5-year actuarial local control (P=0.78). CONCLUSION Robotic assistance in transoral lateral oropharyngectomy for T1-2 tonsillar fossa SCC did not significantly impact oncologic or functional outcome.
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Affiliation(s)
- K Shenouda
- Service d'otorhinolaryngologie, HEGP, université Paris-Descartes Sorbonne Paris-Cité, AP-HP, 20-40, rue Leblanc, 75015 Paris, France
| | - F Rubin
- Clinique St-Vincent, 97404 Saint-Denis cedex, Reunion
| | - D Garcia
- Clinique d'Arcachon, 33164, La Teste de Buch, France
| | - C Badoual
- Service d'anatomopathologie, HEGP, université Paris-Descartes Sorbonne Paris-Cité, AP-HP, 75015 Paris, France
| | - P Bonfils
- Service d'otorhinolaryngologie, HEGP, université Paris-Descartes Sorbonne Paris-Cité, AP-HP, 20-40, rue Leblanc, 75015 Paris, France
| | - O Laccourreye
- Service d'otorhinolaryngologie, HEGP, université Paris-Descartes Sorbonne Paris-Cité, AP-HP, 20-40, rue Leblanc, 75015 Paris, France.
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Mohamed A, Paleri V, George A. A cadaveric study quantifying the anatomical landmarks of the facial artery and its parapharyngeal branches for safe transoral surgery. Head Neck 2019; 41:3389-3394. [DOI: 10.1002/hed.25862] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 06/13/2019] [Accepted: 06/18/2019] [Indexed: 12/11/2022] Open
Affiliation(s)
| | | | - Ajith George
- Keele University Medical School Staffordshire UK
- University Hospitals North Midlands North Staffordshire UK
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