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Kim GJ, Shin HI, Bang J, Sun DI, Kim SY. Assessment of oncologic and cosmetic outcomes of robotic elective neck dissection in early-stage tongue cancer. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108548. [PMID: 39047329 DOI: 10.1016/j.ejso.2024.108548] [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: 04/15/2024] [Revised: 06/19/2024] [Accepted: 07/12/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Robotic neck dissection is emerging as an alternative to conventional open neck dissection. However, the oncologic safety of robotic elective neck dissection (END) and its indications in early-stage tongue cancer are unclear. METHODS We retrospectively reviewed the data of 78 patients who underwent transoral excision for T1, T2 squamous cell carcinoma of tongue with simultaneous ipsilateral END. Patients were assigned to two groups: the robotic group (n = 32)-postauricular face-lift -and the conventional group (n = 46)- transcervical incision. We compared the survival, clinical, pathologic and cosmetic outcomes of the two groups, and evaluated the number of retrieved lymph nodes and robot console time in the robotic group. RESULTS The mean age was lower in the robotic group (43.6 ± 12.8 vs. 55.8 ± 14.0, p < 0.001) and the conventional group had more T2 patients (p = 0.01). The mean operation time was significantly longer in the robotic group than the conventional group (178.81 ± 33.9 vs. 92.28 ± 16.7, p < 0.001). The mean number of retrieved lymph nodes was not significantly different between the two groups (19.22 ± 8.51 vs. 20.7 ± 11.4, p = 0.41). The 5-year disease-free survival rate was not significantly different between the two groups (93.6 % vs. 82.9 %, p = 0.59). Overall scar satisfaction assessed by VAS score, the robotic group showed significantly better results compared to the conventional group (8.38 vs. 5.86, p = 0.033). CONCLUSION Robotic END by a postauricular facelift approach is a feasible and safe approach for early-stage tongue cancer.
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Affiliation(s)
- Geun-Jeon Kim
- Department of Otorhinolaryngology and Head&Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, South Korea
| | - Hyun-Il Shin
- Department of Otorhinolaryngology and Head&Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, South Korea
| | - Jooin Bang
- Department of Otorhinolaryngology and Head&Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, South Korea
| | - Dong-Il Sun
- Department of Otorhinolaryngology and Head&Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, South Korea
| | - Sang-Yeon Kim
- Department of Otorhinolaryngology and Head&Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, South Korea.
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Snyder V, Smith B, Kim S, Spector ME, Duvvuri U. Evaluation of the safety and effectiveness of robot-assisted neck dissections. Head Neck 2024; 46:1331-1339. [PMID: 38488336 DOI: 10.1002/hed.27731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/27/2024] [Accepted: 03/03/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND Robot-assisted neck dissection (RAND) for the management of the regional lymphatic basin offers the potential for improved cosmesis and reduced lymphedema. While RAND has been previously described, functional outcome and oncologic control rates need further elucidation. METHODS A retrospective, matched cohort study of neck dissections completed at UPMC from 2017 to 2021 was conducted. RAND was identified and matched to open neck dissections (open) in a 1:2 ratio. Matching characteristics included primary cancer site, pre-operative clinical N-stage, age at time of surgery, HPV status, and previous chemoradiation treatment (salvage vs. nonsalvage procedure). Additional information was collected on patient demographics, surgery characteristics, and outcomes. Comparisons were made using t-test, chi-square test, Fisher's exact test, and Kaplan-Meier Wilcoxon (KMW) test with p < 0.05 indicating significance. RESULTS Overall, RAND and open groups had similar distributions of age, gender, BMI, primary site of cancer, HPV status, clinical N-stage, clinical T-stage, known neck disease prior to procedure, prior chemoradiation therapy, and level(s) of neck dissection. Surgically, RAND procedures yielded less drainage on average (124 mL in RAND vs. 220 mL in open approaches; p = 0.01). There was no difference in the rates of complications, estimated blood loss, or number of lymph nodes obtained. There were also no differences in the rates of adjuvant therapy. Long term, there were no differences in the rates of local, locoregional, and distant recurrence of primary disease between RAND and open procedures. There were also no differences in postprocedure disease-free survival time (KMW p-value = 0.32; HR [of RAND compared with open] = 0.62). Similarly, there were no statistical differences in the overall survival of RAND patients when compared with the open group (75 vs. 58.9 months; HR = 0.11, p = 0.87). CONCLUSION This study is the first to report the long-term effectiveness of robot-assisted surgery compared with the traditional, open approach. In addition to well-known cosmetic benefits, robot-assisted surgery may also offer patients a reduction in uncomfortable drains and improved effects from lymphedema. Overall, this study provides initial data that the RAND may be considered as an alternative approach to open surgery.
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Affiliation(s)
- Vusala Snyder
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Brandon Smith
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Seungwon Kim
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Matthew E Spector
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Umamaheswar Duvvuri
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Robot-Assisted Total Thyroidectomy with or without Robot-Assisted Neck Dissection in Pediatric Patients with Differentiated Thyroid Cancer. J Clin Med 2022; 11:jcm11123320. [PMID: 35743391 PMCID: PMC9224679 DOI: 10.3390/jcm11123320] [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: 05/09/2022] [Revised: 05/27/2022] [Accepted: 05/29/2022] [Indexed: 12/04/2022] Open
Abstract
Pediatric thyroid cancer more frequently develops cervical node metastasis than adult thyroid cancer, even in differentiated thyroid carcinoma (DTC). Thus, cervical neck dissection often needs to be performed simultaneously with thyroidectomy in pediatric patients. Herein, we describe our experience with robot-assisted total thyroidectomy with/without robot-assisted neck dissection in pediatric patients compared with the conventional operated group. A total of 30 pediatric patients who underwent thyroidectomy for DTC between July 2011 and December 2019 were retrospectively reviewed. Among them, 22 underwent robot-assisted operation, whereas 8 underwent conventional operation. There was no statistical difference in the mean operation times, blood loss, drainage amounts, and hospital stay length between the robot-assisted and conventional operation groups; however, the operation time was less in the retroauricular approach subgroup (robot-assisted operation group) with better satisfaction on cosmesis. No postoperative complications, such as seromas, hemorrhages, or hematomas were observed. Our experience suggested that robot-assisted thyroidectomy with or without neck dissection through the retroauricular approach is a feasible and safe alternative treatment, producing outstanding esthetic results compared to the conventional approach, especially in pediatric patients with DTC.
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Jat B, Majumdar KS, Thaduri A, Usmani SA, Dave J, Kumar A, Tyagi AK. Robot assisted modified retro-auricular approach for posterior triangle of neck: The path differently taken. Oral Oncol 2021; 124:105633. [PMID: 34856510 DOI: 10.1016/j.oraloncology.2021.105633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 11/10/2021] [Accepted: 11/14/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Bhinyaram Jat
- Department of Otorhinolaryngology and Head & Neck Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
| | - Kinjal Shankar Majumdar
- Department of Otorhinolaryngology and Head & Neck Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Abhinav Thaduri
- Department of Otorhinolaryngology and Head & Neck Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Shahab Ali Usmani
- Department of Otorhinolaryngology and Head & Neck Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Jay Dave
- Department of Otorhinolaryngology and Head & Neck Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Amit Kumar
- Department of Otorhinolaryngology and Head & Neck Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Amit Kumar Tyagi
- Department of Otorhinolaryngology and Head & Neck Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Recent progress of robotic head and neck surgery using a flexible single port robotic system. J Robot Surg 2021; 16:353-360. [PMID: 33939137 DOI: 10.1007/s11701-021-01221-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 02/26/2021] [Indexed: 10/21/2022]
Abstract
We performed robotic neck surgery through a transoral or retroauricular approach (RA) using the DaVinci SP and analyzed our experiences to evaluate the feasibility and safety of this system for performing RA neck surgeries. A total of 63 patients were enrolled in this study, consisting of 37 males and 26 females. All operations were successfully completed without significant complication in 63 patients with head and neck tumor. Using DaVinci SP, it is easy to insert three robotic arms into a long and narrow working space because all robotic arms and an endoscope are inserted through a single arm. Using the navigation function of the DaVinci SP, the endoscopic arm could be made into the shape of a "cobra" to secure proper visualization of the surgical site, which helps surgeons identify specific anatomic structures such as cranial nerve or vessels. We did not have any cases where robotic surgery was converted to open surgery due to severe bleeding or technical issues during surgery. The mean operative time was 207 min and the average hospital stay was 6.9 days. The time required for docking the surgical robot was within 10 min on average for DaVinci SP, which was much simpler and faster than that of the previous Si/Xi system. Based on our early experiences performing robotic head and neck surgery using the DaVinci SP, we confirmed that the system provided advanced technical advantages over the previous Si/Xi system in performing robotic surgery.
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Acceptance and adoption of transoral robotic surgery in Germany. Eur Arch Otorhinolaryngol 2021; 278:4021-4026. [PMID: 33550435 PMCID: PMC8382611 DOI: 10.1007/s00405-021-06623-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 01/13/2021] [Indexed: 10/28/2022]
Abstract
PURPOSE Since its introduction over a decade ago, the use of robotic surgery (RS) in head and neck surgery has widely spread around the globe, with very differential adoption of this novel surgical technique in different parts of the world. In this study, we analyze the acceptance and adoption of robotic surgery in the head and neck in Germany. MATERIALS AND METHODS A cross-sectional analysis using a questionnaire evaluating the acceptance and adoption of RS was performed. Questionnaires were distributed to all chairmen /-women of Otorhinolaryngology, Head and Neck Surgery Departments in Germany. RESULTS A total of 107 respondents completed the questionnaire (65.2%). At university hospitals, 71.4% of the respondents indicated that a robotic system was available, and 21.4% responded that robotic surgery was performed at their institution; 22.7% and 0.04%, respectively, at non-university hospitals. The overall adoption rate was 0.8%. The most common cases performed were TORS resection in the oropharynx. Main reasons for not adopting this technique were costs, lack of interest and available co-operations. CONCLUSION This study provides evidence of the extent of adoption of TORS in Germany; main perceived barriers to adoption are costs with lack of cost-covering reimbursement and insufficient co-operations with other disciplines as well as hospital administration resulting in a very low adoption rate of this technique over the past decade. Results from this study may assist in decision-making processes on adopting this technique in the future.
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Abstract
PURPOSE OF REVIEW The progressive growth of endoscopic and robotic-assisted procedures provided the tools for development of remote approaches to the neck, which could avoid a visible large neck scar usually necessary for neck dissections. This review explores the current experience with robotic neck dissection, looking for pros and cons in surgical, oncologic and aesthetic outcomes. RECENT FINDINGS Robotic neck dissection was shown to be feasible and well tolerated, with adequate oncological outcomes in different tumours. Although difficult to objectively analyse, cosmetic satisfaction seems to be significatively higher in patients submitted to this procedure when compared with those submitted to conventional neck dissection. The only consistently reported disadvantage was longer operative time. Other potential advantages beyond cosmesis such as improvements on oedema, fibrosis, neck movement, sensory loss and social interactions were not well explored so far. SUMMARY Surgical treatment of neck metastasis had several evolutions in the last decades. Robotic neck dissection emerged as an option to avoid extensive visible neck scars, improving cosmesis and probably other functional outcomes, although securing oncologic effectiveness. Technological innovation is increasingly dynamic, promising progressive evolution in robotic surgery. Together, the lack of objective data on functional outcomes warrants the need for further investigation on robotic neck dissection.
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Park YM, Kim DH, Kang MS, Lim JY, Choi EC, Kim SH, Koh YW. Establishing the robotic surgery procedure and techniques for head and neck tumors: a single surgeon's experience of 945 cases. J Robot Surg 2020; 14:871-880. [PMID: 32206978 DOI: 10.1007/s11701-020-01068-5] [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: 11/25/2019] [Accepted: 03/16/2020] [Indexed: 11/30/2022]
Abstract
We suggested operative techniques and indications of robotic neck surgery. To determine operative techniques and the indications for robotic neck surgery, we analyzed treatment outcomes of patients who received robotic neck surgery. Between May 2010 and July 2018, a total of 945 patients with various neck diseases visited Severance Hospital and underwent robotic neck surgery. A variety of approaches, including the retroauricular approach (RA), modified facelift approach (MFLA), transaxillary approach (TA), and transaxillary retroauricular approach (TARA), was used to remove various tumors in the neck. A total of 235 patients underwent a robotic neck dissection (elective or therapeutic) in the treatment of head and neck cancer with metastatic cervical lymph nodes. Five hundred-seventeen patients underwent robotic thyroidectomy or parathyroidectomy for thyroid or parathyroid disease, respectively. The remaining 193 patients underwent robotic neck surgery in the treatment of other neck diseases. Various neck lesions were successfully excised using RA or MFLA (including salivary gland tumors, thyroid tumors, vascular tumors, neurogenic tumors, lipomas, lymphangiomas, venous malformations, dermoid cysts, and others). Robotic neck surgery is a feasible and safe technique for the resection of various head and neck tumors. This method could be particularly useful in young patients with thyroid tumors, salivary gland tumors, and vascular tumors, among others, because it does not leave a visible scar on the face or neck. The superior visualization and articulate robotic arm that moves freely at various angles allows surgeons to perform delicate and precise surgeries.
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Affiliation(s)
- Young Min Park
- Department of Otorhinolaryngology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Da Hee Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Min Seok Kang
- Department of Otorhinolaryngology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Jae-Yol Lim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Eun Chang Choi
- Department of Otorhinolaryngology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Se-Heon Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Yoon Woo Koh
- Department of Otorhinolaryngology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
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Byeon HK, Holsinger FC, Duvvuri U, Kim DH, Park JH, Chang E, Kim SH, Koh YW. Recent progress of retroauricular robotic thyroidectomy with the new surgical robotic system. Laryngoscope 2017; 128:1730-1737. [PMID: 29068059 DOI: 10.1002/lary.26938] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 05/24/2017] [Accepted: 08/29/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Previously, we have reported the feasibility of retroauricular (RA) robotic thyroidectomy. Despite its promising surgical outcomes, there were certain intrinsic mechanical limitations inherent to the da Vinci Si System (Intuitive Surgical, Sunnyvale, California, U.S.A.). Since the advent of an upgraded model, the Xi System (Intuitive Surgical), we have actively incorporated the new model into performing RA thyroidectomy. Here, we intend to verify the feasibility of RA robotic thyroidectomy using the new da Vinci Xi System (Intuitive Surgical) with comparison of the former Si-applied surgery (Intuitive Surgical). STUDY DESIGN Comparative analysis. METHODS There were total 165 consecutive patients who received RA robotic thyroidectomy from January 2013 to February 2016. The patients were divided into two groups: Si group (n = 125) and Xi group (n = 40). Perioperative and treatment outcomes were compared and analyzed. RESULTS Compared with the previous system, new da Vinci Xi system (Intuitive Surgical) enabled insertion of an extra third robotic instrumental arm. Unlike the previous robotic surgical technique, the robotic dissection could be initiated immediately after the establishment of working space and the resulting total operation time could be significantly decreased. There was no difference in the surgical completeness, as confirmed by postoperative thyroglobulin levels. Additionally, flexed EndoWrist (Intuitive Surgical) instruments equipped with the Erbe (Erbe USA Inc., Marietta, Georgia, U.S.A.) system could be mounted, which further facilitated the operation. There were no significant differences in postoperative complications between the two groups. CONCLUSION The RA robotic thyroidectomy with the new Xi System (Intuitive Surgical) can greatly facilitate the robotic surgery with comparable or improved surgical outcomes. Its application is expected to open up a new era of robotic neck surgery. LEVEL OF EVIDENCE 4. Laryngoscope, 128:1730-1737, 2018.
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Affiliation(s)
- Hyung Kwon Byeon
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul
| | - F Christopher Holsinger
- Division of Head & Neck Surgery, Department of Otolaryngology, Stanford University School of Medicine, Stanford, California
| | - Umamaheswar Duvvuri
- Department of Otorhinolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Da Hee Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul
| | - Jae Hong Park
- Department of Otorhinolaryngology, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Estelle Chang
- Department of Otolaryngology Head and Neck Surgery, University of Nebraska Medical Center, Omaha, Nebraska, U.S.A
| | - Se-Heon Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul
| | - Yoon Woo Koh
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul
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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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Liu HH, Li LJ, Shi B, Xu CW, Luo E. Robotic surgical systems in maxillofacial surgery: a review. Int J Oral Sci 2017; 9:63-73. [PMID: 28660906 PMCID: PMC5518975 DOI: 10.1038/ijos.2017.24] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2017] [Indexed: 12/26/2022] Open
Abstract
Throughout the twenty-first century, robotic surgery has been used in multiple oral surgical procedures for the treatment of head and neck tumors and non-malignant diseases. With the assistance of robotic surgical systems, maxillofacial surgery is performed with less blood loss, fewer complications, shorter hospitalization and better cosmetic results than standard open surgery. However, the application of robotic surgery techniques to the treatment of head and neck diseases remains in an experimental stage, and the long-lasting effects on surgical morbidity, oncologic control and quality of life are yet to be established. More well-designed studies are needed before this approach can be recommended as a standard treatment paradigm. Nonetheless, robotic surgical systems will inevitably be extended to maxillofacial surgery. This article reviews the current clinical applications of robotic surgery in the head and neck region and highlights the benefits and limitations of current robotic surgical systems.
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Affiliation(s)
- Hang-Hang Liu
- State Key Laboratory of Oral
Diseases, National Clinical Research Center for Oral Diseases, West China
Hospital of Stomatology, Sichuan University, Chengdu,
China
| | - Long-Jiang Li
- State Key Laboratory of Oral
Diseases, National Clinical Research Center for Oral Diseases, West China
Hospital of Stomatology, Sichuan University, Chengdu,
China
| | - Bin Shi
- State Key Laboratory of Oral
Diseases, National Clinical Research Center for Oral Diseases, West China
Hospital of Stomatology, Sichuan University, Chengdu,
China
| | - Chun-Wei Xu
- State Key Laboratory of Oral
Diseases, National Clinical Research Center for Oral Diseases, West China
Hospital of Stomatology, Sichuan University, Chengdu,
China
| | - En Luo
- State Key Laboratory of Oral
Diseases, National Clinical Research Center for Oral Diseases, West China
Hospital of Stomatology, Sichuan University, Chengdu,
China
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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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Byeon HK, Kim DH, Chang JW, Ban MJ, Park JH, Kim WS, Choi EC, Koh YW. Comprehensive application of robotic retroauricular thyroidectomy: The evolution of robotic thyroidectomy. Laryngoscope 2015; 126:1952-7. [PMID: 26525822 DOI: 10.1002/lary.25763] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 08/17/2015] [Accepted: 10/05/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS As an evolvement of the robotic application to the thyroidectomy, we sought to seek the potential role of robotic thyroidectomy with the retroauricular (RA) approach prior to future comparative study between RA and transaxillary thyroidectomy. This study aims to verify the surgical feasibility of robotic RA thyroidectomy. STUDY DESIGN Case series with planned data collection. METHODS A total of 87 patients who underwent robotic RA thyroidectomy for clinically suspicious papillary thyroid carcinoma or benign lesions from January 2013 to May 2014 were retrospectively reviewed and analyzed. RESULTS All robotic surgeries via RA approach were successfully performed, without any significant intraoperative complications or conversion to open surgery. Based on patient-reported outcome questionnaires, all patients were satisfied with their postoperative surgical scars. CONCLUSION Robotic RA thyroidectomy is technically feasible and safe, with satisfactory cosmetic results for patients where indicated. LEVEL OF EVIDENCE 4. Laryngoscope, 126:1952-1957, 2016.
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Affiliation(s)
- Hyung Kwon Byeon
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Da Hee Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae Won Chang
- Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Myung Jin Ban
- Department of Otorhinolaryngology, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Jae Hong Park
- Department of Otorhinolaryngology, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Won Shik Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Chang Choi
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yoon Woo Koh
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea
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Byeon HK, Koh YW. The new era of robotic neck surgery: The universal application of the retroauricular approach. J Surg Oncol 2015; 112:707-16. [DOI: 10.1002/jso.24019] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 08/08/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Hyung Kwon Byeon
- Department of Otorhinolaryngology; Yonsei University College of Medicine; Seoul Republic of Korea
| | - Yoon Woo Koh
- Department of Otorhinolaryngology; Yonsei University College of Medicine; Seoul Republic of Korea
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Albergotti WG, Byrd JK, Nance M, Choi EC, Koh YW, Kim S, Duvvuri U. Robot-Assisted Neck Dissection Through a Modified Facelift Incision. Ann Otol Rhinol Laryngol 2015; 125:123-9. [DOI: 10.1177/0003489415601127] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: The aim of this study is to describe the feasibility as well as oncologic outcomes of robot-assisted neck dissection (RAND) through a modified facelift incision in an American population. Study Design: Retrospective case series. Setting: University tertiary care hospital. Methods: All patients who underwent RAND between November 2012 and December 2014 were included. Medical records were reviewed for demographics, medical histories, staging, operative information, postoperative hospital course and complications, and oncologic outcomes. Results: There were 11 RANDs identified among 10 patients. Five patients had known nodal metastasis at the time of surgery. Two patients had been previously irradiated. The average time of surgery was 284.4 ± 72.3 minutes, including other associated procedures. The average lymph node yield was 28.5 ± 9.3 nodes. There were no major complications. Average follow-up was 19.4 months. There was 1 supraclavicular recurrence in a previously irradiated patient. All patients are currently alive and without evidence of disease. Conclusions: Robot-assisted neck dissection is a safe and feasible procedure that can be performed by surgeons with familiarity with neck dissection and robot-assisted surgery and who have been trained in RAND. Appropriate oncologic outcomes can be obtained in a patient wishing to avoid a noticeable scar.
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Affiliation(s)
- William G. Albergotti
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - James K. Byrd
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Melonie Nance
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Veterans Affairs Pittsburgh Health System, Pittsburgh, Pennsylvania, USA
| | - Eun Chang Choi
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, South Korea
| | - Yoon Woo Koh
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, South Korea
| | - Seungwon Kim
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Umamaheswar Duvvuri
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Veterans Affairs Pittsburgh Health System, Pittsburgh, Pennsylvania, USA
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