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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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Abstract
SUMMARY Vascularized tissue for obliteration of large pelvic dead spaces created by extirpative surgery has been shown to reduce complication rates. As more extensive resections are performed robotically, plastic surgeons have been challenged to reconstruct the resulting defects using a minimally invasive approach. The goal of this study was to report the authors' experience with robotic harvest of the rectus abdominis muscle for reconstruction of pelvic defects. The authors conducted a retrospective case series of patients who underwent robotic flap harvest following robotic extirpative surgery at their institution. Patient demographics, surgical characteristics, and postoperative outcomes were collected. These were compared to a retrospective cohort of patients who underwent open rectus abdominis muscle harvest. The authors identified seven male patients who underwent robotic flap harvest for pelvic reconstruction between 2013 and 2019. Their mean age was 66 ± 6 years and mean body mass index was 31 ± 5 kg/m2. Six patients (86 percent) had a history of radiation therapy and five patients (71 percent) received hormone therapy or chemotherapy. Surgical-site complications occurred in two patients. One patient developed ventral hernia. The donor-site complication rate was 19 percent (n = 18) in patients who underwent open rectus abdominis muscle harvest (n = 95). This study demonstrates the safety, efficacy, and reproducibility of robotic harvest of the rectus abdominis muscle in complex, multidisciplinary, minimally invasive pelvic surgery. The technique avoids violation of the anterior rectus sheath and wound complications related to open flap harvest, and early experience suggests reduced donor-site morbidity. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Suchyta M, Mardini S. Innovations and Future Directions in Head and Neck Microsurgical Reconstruction. Clin Plast Surg 2020; 47:573-593. [PMID: 32892802 DOI: 10.1016/j.cps.2020.06.009] [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] [Indexed: 11/19/2022]
Abstract
Head and neck reconstructive microsurgery is constantly innovating because of a combination of multidisciplinary advances. This article examines recent innovations that have affected the field as well as presenting research leading to future advancement. Innovations include the use of virtual surgical planning and three-dimensional printing in craniofacial reconstruction, advances in intraoperative navigation and imaging, as well as postoperative monitoring, development of minimally invasive reconstructive microsurgery techniques, integration of regenerative medicine and stem cell biology with reconstruction, and the dramatic advancement of face transplant.
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Affiliation(s)
- Marissa Suchyta
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, MA1244W, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Samir Mardini
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, MA1244W, 200 First Street Southwest, Rochester, MN 55905, USA.
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Facial artery musculomucosal flaps in oropharyngeal reconstruction following salvage transoral robotic surgery: a review of outcomes. The Journal of Laryngology & Otology 2019; 133:884-888. [PMID: 31475640 DOI: 10.1017/s002221511900183x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE There has been little reported on the transoral reconstructive options following salvage transoral robotic surgery. This paper describes the facial artery musculomucosal flap as a method to introduce vascularised tissue to a previously irradiated resection bed. METHODS A facial artery musculomucosal flap was used to reconstruct the lateral pharyngeal wall in 13 patients undergoing salvage transoral robotic surgery for oropharyngeal squamous cell carcinoma. Outcomes recorded include flap and donor site complications, length of stay, and swallowing and speech outcomes. RESULTS There were no immediate or late flap complications, or cases of delayed wound healing in this series. There were two facial artery musculomucosal related complications requiring surgical management: one bleed from the facial artery musculomucosal donor site and one minor surgical revision. Healing of the flap onto the resection bed was successful in all cases. CONCLUSION The facial artery musculomucosal flap provides a suitable transoral local flap option for selected patients undergoing salvage transoral robotic surgery for oropharyngeal malignancies.
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Reconstruction of Oropharyngeal Defects After Transoral Robotic Surgery. Review and Recommendations of the Commission of Head and Neck Surgery of the Spanish Society of Otolaryngology and Head and Neck Surgery. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2019. [DOI: 10.1016/j.otoeng.2019.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Reconstrucción de defectos orofaríngeos tras cirugía transoral robótica. Revisión y recomendaciones de la Comisión de Cirugía de Cabeza y Cuello de la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2019; 70:235-244. [DOI: 10.1016/j.otorri.2018.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 04/07/2018] [Accepted: 04/12/2018] [Indexed: 11/18/2022]
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Podolsky DJ, Diller E, Fisher DM, Wong Riff KW, Looi T, Drake JM, Forrest CR. Utilization of Cable Guide Channels for Compact Articulation Within a Dexterous Three Degrees-of-Freedom Surgical Wrist Design. J Med Device 2018. [DOI: 10.1115/1.4041591] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Pin-jointed wrist mechanisms provide compact articulation for surgical robotic applications, but are difficult to miniaturize at scales suitable for small body cavity surgery. Solid surface cable guide channels, which eliminate the need for pulleys and reduce overall length to facilitate miniaturization, were developed within a three-degree-of-freedom cable-driven pin-jointed wrist mechanism. A prototype was 3D printed in steel at 5 mm diameter. Friction generated by the guide channels was experimentally tested to determine increases in cable tension during constant cable velocity conditions. Cable tension increased exponentially from 0 to 37% when the wrist pitched from 0 deg to 90 deg. The shape of the guide channel groove and angle, where the cable exits the channel impacts the magnitude of cable tension. A spring tensioning and cam actuation mechanism were developed to account for changing cable circuit path lengths during wrist pitch. This work shows that pulley-free cable wrist mechanisms can facilitate miniaturization below current feasible sizes while retaining compact articulation at the expense of increases in friction under constant cable velocity conditions.
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Affiliation(s)
- Dale J. Podolsky
- University of Toronto, The Hospital for Sick Children, 5430-555 Hill Wing, University Avenue, Toronto, ON M5G 1X8, Canada e-mail:
| | - Eric Diller
- Mem. ASME Department of Mechanical and Industrial Engineering, University of Toronto, 5 King's College Road, MC310, Toronto, ON M5S 3G8, Canada e-mail:
| | - David M. Fisher
- University of Toronto, The Hospital for Sick Children, 5430-555 Hill Wing, University Avenue, Toronto, ON M5G 1X8, Canada e-mail:
| | - Karen W. Wong Riff
- University of Toronto, The Hospital for Sick Children, 5418-555 Hill Wing, University Avenue, Toronto, ON M5G 1X8, Canada e-mail:
| | - Thomas Looi
- University of Toronto, The Hospital for Sick Children, 7142-555 Burton Wing, University Avenue, Toronto, ON M5G 1X8, Canada e-mail:
| | - James M. Drake
- University of Toronto, The Hospital for Sick Children, 1504-555 Hill Wing, University Avenue, Toronto, ON M5G 1X8, Canada e-mail:
| | - Christopher R. Forrest
- University of Toronto, The Hospital for Sick Children, 5430-555 Hill Wing, University Avenue, Toronto, ON M5G 1X8, Canada e-mail:
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Abstract
A look at the past, present and future.
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Affiliation(s)
- George Garas
- Department of Otorhinolaryngology - Head and Neck Surgery St Mary's Hospital, Imperial College London
| | - Neil Tolley
- Department of Otorhinolaryngology - Head and Neck Surgery St Mary's Hospital, Imperial College London
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Struk S, Qassemyar Q, Leymarie N, Honart JF, Alkhashnam H, De Fremicourt K, Conversano A, Schaff JB, Rimareix F, Kolb F, Sarfati B. The ongoing emergence of robotics in plastic and reconstructive surgery. ANN CHIR PLAST ESTH 2018; 63:105-112. [DOI: 10.1016/j.anplas.2018.01.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 01/02/2018] [Indexed: 12/25/2022]
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Chan JYW, Chan RCL, Chow VLY, Tsang RKY, Wong STS, Wei WI. Transoral robotic total laryngopharyngectomy and free jejunal flap reconstruction for hypopharyngeal cancer. Oral Oncol 2017; 72:194-196. [DOI: 10.1016/j.oraloncology.2017.06.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 06/22/2017] [Accepted: 06/29/2017] [Indexed: 10/19/2022]
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Transoral robotic-assisted surgery for the approach to anterior cervical spine lesions. Eur Arch Otorhinolaryngol 2017; 274:4011-4016. [PMID: 28864959 DOI: 10.1007/s00405-017-4731-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 08/22/2017] [Indexed: 10/18/2022]
Abstract
The Da Vinci robotic surgical system is increasingly being used by head and neck surgeons in transoral approaches for head and neck cancer. Our experience using the Da Vinci system for transoral robotic-assisted surgery (TORS) is presented. The feasibility of TORS for lesions involving the anterior portion of C1-C2 and the cranio-cervical junction has been evaluated from an anatomical viewpoint in a cadaveric laboratory. Two patients treated using the Da Vinci system to reach C1-C2 benign lesions are presented. The anatomical cadaveric study showed that this approach is safe and feasible. The first two cases which we describe confirmed the advantages of the Da Vinci system in the anterior approach to the cervical spine and allowed the limitations of this procedure to be assessed. TORS may be useful to reach anterior lesions of the cervical spine localized at the level of C1 and C2: first, for removal of small benign and well-delineated lesions; and second, for diagnostic purposes with biopsy of large lesions. Further studies and new instruments are needed to confirm the safety and results of this approach in terms of morbidity.
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Hamilton D, Paleri V. Role of transoral robotic surgery in current head & neck practice. Surgeon 2017; 15:147-154. [DOI: 10.1016/j.surge.2016.09.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 09/13/2016] [Indexed: 11/25/2022]
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Suchyta M, Mardini S. Innovations and Future Directions in Head and Neck Microsurgical Reconstruction. Clin Plast Surg 2017; 44:325-344. [DOI: 10.1016/j.cps.2016.11.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Biron VL, O'Connell DA, Barber B, Clark JM, Andrews C, Jeffery CC, Côté DWJ, Harris J, Seikaly H. Transoral robotic surgery with radial forearm free flap reconstruction: case control analysis. J Otolaryngol Head Neck Surg 2017; 46:20. [PMID: 28292318 PMCID: PMC5351107 DOI: 10.1186/s40463-017-0196-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 03/07/2017] [Indexed: 11/10/2022] Open
Abstract
Background The resection of large oropharyngeal tumors traditionally involves a lip-splitting mandibulotomy for adequate margin visualization and free flap reconstruction of the surgical defect. Transoral robotic surgery (TORS) has emerged as a technique that can resect large and complex oropharyngeal tumors, avoiding a lip-splitting approach. The aim of this study is to compare the lip-splitting mandibulotomy approach versus TORS for the management of advanced stage oropharyngeal carcinomas. Methods Prospectively collected data from 18 patients with advanced stage oropharyngeal squamous cell carcinoma (OPSCC) who received TORS with radial forearm free flap reconstruction (RFFF) was compared to a matched cohort of 39 patients who received a lip-splitting mandibulotomy and RFFF. Patients were matched for stage, p16 positivity, smoking, age and gender. Length of hospital stay (LOHS), tracheostomy decanulation time, operative time, surgical margin status, and post-operative complications were compared between groups. Results Patients who received TORS with RFFF had a significantly lower mean LOHS, compared to patients who were treated by lip-splitting mandibulotomy and RFFF (14.4 vs 19.7 days, p = 0.03). No significant differences were seen between groups in terms of operative time, tracheostomy decannulation time, margin positivity and post-operative complications. Conclusion TORS with radial forearm free flap reconstruction is a safe, effective and cost-saving alternative to the lip-splitting mandibulotomy approach for the treatment of advanced stage OPSCC.
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Affiliation(s)
- Vincent L Biron
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Alberta, 8440-112 st, 1E4 Walter Mackenzie Centre, Edmonton, AB, T6G 2B7, Canada. .,Alberta Head & Neck Centre for Oncology and Reconstruction, Edmonton, AB, Canada.
| | - Daniel A O'Connell
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Alberta, 8440-112 st, 1E4 Walter Mackenzie Centre, Edmonton, AB, T6G 2B7, Canada.,Alberta Head & Neck Centre for Oncology and Reconstruction, Edmonton, AB, Canada
| | - Brittany Barber
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Alberta, 8440-112 st, 1E4 Walter Mackenzie Centre, Edmonton, AB, T6G 2B7, Canada
| | - Jessica M Clark
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Alberta, 8440-112 st, 1E4 Walter Mackenzie Centre, Edmonton, AB, T6G 2B7, Canada
| | - Colin Andrews
- Faculty of Medicine and Dentistry, Undergraduate Medical Education, Edmonton, AB, Canada
| | - Caroline C Jeffery
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Alberta, 8440-112 st, 1E4 Walter Mackenzie Centre, Edmonton, AB, T6G 2B7, Canada
| | - David W J Côté
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Alberta, 8440-112 st, 1E4 Walter Mackenzie Centre, Edmonton, AB, T6G 2B7, Canada
| | - Jeffrey Harris
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Alberta, 8440-112 st, 1E4 Walter Mackenzie Centre, Edmonton, AB, T6G 2B7, Canada.,Alberta Head & Neck Centre for Oncology and Reconstruction, Edmonton, AB, Canada
| | - Hadi Seikaly
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Alberta, 8440-112 st, 1E4 Walter Mackenzie Centre, Edmonton, AB, T6G 2B7, Canada.,Alberta Head & Neck Centre for Oncology and Reconstruction, Edmonton, AB, Canada
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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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Gross ND, Hanna EY. The Role of Surgery in the Management of Recurrent Oropharyngeal Cancer. Recent Results Cancer Res 2016; 206:197-205. [PMID: 27699540 DOI: 10.1007/978-3-319-43580-0_15] [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: 03/15/2023]
Abstract
The incidence of oropharyngeal squamous cell carcinoma (OPSCC) continues to rise worldwide at a dramatic pace, buoyed by the predominance of human papilloma virus (HPV) driven disease (Panwar et al. 2014). While the outcomes of patients with HPV-positive OPSCC are dramatically improved compared to HPV-negative OPSCC, treatment failures do occur. The result is an inevitable rise in the incidence of recurrent OPSCC. Since the majority of incident OPSCC cases are treated with some form of radiation therapy (primary or adjuvant), surgery remains the backbone of treatment for recurrent OPSCC. This section will focus on options for surgical management of recurrent OPSCC.
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Affiliation(s)
- Neil D Gross
- Department Head and Neck Surgery, University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1445, Houston, TX, 77030, USA.
| | - Ehab Y Hanna
- Department Head and Neck Surgery, University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1445, Houston, TX, 77030, USA
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Takácsi-Nagy Z, Martínez-Mongue R, Mazeron JJ, Anker CJ, Harrison LB. American Brachytherapy Society Task Group Report: Combined external beam irradiation and interstitial brachytherapy for base of tongue tumors and other head and neck sites in the era of new technologies. Brachytherapy 2016; 16:44-58. [PMID: 27592129 DOI: 10.1016/j.brachy.2016.07.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 05/30/2016] [Accepted: 07/01/2016] [Indexed: 11/19/2022]
Abstract
Irradiation plays an important role in the treatment of cancers of the head and neck providing a high locoregional tumor control and preservation of organ functions. External beam irradiation (EBI) results in unnecessary radiation exposure of the surrounding normal tissues increasing the incidence of side effects (xerostomy, osteoradionecrosis, and so forth). Brachytherapy (BT) seems to be the best choice for dose escalation over a short treatment period and for minimizing radiation-related normal tissue damage due to the rapid dose falloff around the source. Low-dose-rate BT is being increasingly replaced by pulsed-dose-rate and high-dose-rate BT because the stepping source technology offers the advantage of optimizing dose distribution by varying dwell times. Pulsed-dose and high-dose rates appear to yield local control and complication rates equivalent to those of low-dose rate. BT may be applied alone; but in case of high risk of nodal metastases, it is used together with EBI. This review presents the results and the indications of combined BT and EBI in carcinoma of the base of tongue and other sites of the head and neck region, as well as the role BT plays among other-normal tissue protecting-modern radiotherapy modalities (intensity-modulated radiotherapy, stereotactic radiotherapy) applied in these localizations.
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Affiliation(s)
| | | | - Jean-Jacques Mazeron
- Department of Radiation Oncology, Groupe Hospitelier Pitié-Salpêtrière, Paris, France
| | - Cristopher James Anker
- Department of Radiation Oncology, School of Medicine, University of Utah, Salt Lake City, UT
| | - Louis B Harrison
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL
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Sload R, Silver N, Jawad BA, Gross ND. The Role of Transoral Robotic Surgery in the Management of HPV Negative Oropharyngeal Squamous Cell Carcinoma. Curr Oncol Rep 2016; 18:53. [DOI: 10.1007/s11912-016-0541-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Dutta SR, Passi D, Sharma S, Singh P. Transoral robotic surgery: A contemporary cure for future maxillofacial surgery. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY MEDICINE AND PATHOLOGY 2016. [DOI: 10.1016/j.ajoms.2016.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Mattheis S, Kansy B, Haßkamp P, Holtmann L, Lang S. Fortschritte in der transoralen roboterassistierten Chirurgie. HNO 2015; 63:752-7. [DOI: 10.1007/s00106-015-0073-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Transoral ultrasonic total laryngectomy (TOUSS-TL): description of a new endoscopic approach and report of two cases. Eur Arch Otorhinolaryngol 2015; 273:2689-96. [PMID: 26429149 PMCID: PMC4974296 DOI: 10.1007/s00405-015-3784-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 09/12/2015] [Indexed: 11/12/2022]
Abstract
The minimally invasive total laryngectomy avoids a wide surgical field and so it has the potential benefit of reducing the local morbidity, especially on radiated patients. This approach has been previously described on a robotic basis, the transoral robotic total laryngectomy (TORS-TL). We have designed a minimally invasive approach for total laryngectomy (TL) using the transoral ultrasonic surgery technique (TOUSS). TOUSS is a transoral, endoscopic, non-robotic approach for laryngeal and pharyngeal tumors, based on the ultrasonic scalpel as a resection tool. Two patients with a laryngeal squamous cell carcinoma with indication for total laryngectomy were surgically treated: one primary TL for a subglottic carcinoma and one salvage TL with partial pharyngectomy for a local relapse after chemoradiotherapy of a glottic carcinoma. The tumors were completely removed with free surgical margin in both patients. The functional recovery was satisfactory in terms of swallowing and speech (a tracheoesophageal puncture and voice prosthesis placement were done in the same procedure). No intraoperative complications were observed. The patient with previous chemoradiotherapy had a pharyngocutaneous fistula which closed spontaneously without additional surgery. We have demonstrated that transoral endoscopic approach to the larynx and pharynx is feasible without a robotic platform. TOUSS-TL can easily spread the transoral endoscopic philosophy as well as the benefits of a minimally invasive way to remove the entire larynx. Further research will show the advantages in terms of complications and functional outcomes.
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Janetschek G. Robotics: Will they give a new kick to single-site surgery? Eur Urol 2014; 66:1044-5. [PMID: 25123322 DOI: 10.1016/j.eururo.2014.07.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 07/18/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Günter Janetschek
- Department of Urology, Medical University Salzburg, Salzburg, Austria.
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