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Cleere EF, Read C, Prunty S, Duggan E, O'Rourke J, Moore M, Vasquez P, Young O, Subramaniam T, Skinner L, Moran T, O'Duffy F, Hennessy A, Dias A, Sheahan P, Fitzgerald CWR, Kinsella J, Lennon P, Timon CVI, Woods RSR, Shine N, Curley GF, O'Neill JP. Airway decision making in major head and neck surgery: Irish multicenter, multidisciplinary recommendations. Head Neck 2024. [PMID: 38984517 DOI: 10.1002/hed.27868] [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: 06/21/2024] [Accepted: 06/30/2024] [Indexed: 07/11/2024] Open
Abstract
Major head and neck surgery poses a threat to perioperative airway patency. Adverse airway events are associated with significant morbidity, potentially leading to hypoxic brain injury and even death. Following a review of the literature, recommendations regarding airway management in head and neck surgery were developed with multicenter, multidisciplinary agreement among all Irish head and neck units. Immediate extubation is appropriate in many cases where there is a low risk of adverse airway events. Where a prolonged definitive airway is required, elective tracheostomy provides increased airway security postoperatively while delayed extubation may be appropriate in select cases to reduce postoperative morbidity. Local institutional protocols should be developed to care for a tracheostomy once inserted. We provide guidance on decision making surrounding airway management at time of head and neck surgery. All decisions should be agreed between the operating, anesthetic, and critical care teams.
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Affiliation(s)
- Eoin F Cleere
- Department of Otolaryngology - Head and Neck Surgery, Beaumont Hospital, Dublin, Ireland
| | - Christopher Read
- Department of Anaesthesia and Critical Care, Beaumont Hospital, Dublin, Ireland
| | - Sarah Prunty
- Department of Otolaryngology - Head and Neck Surgery, Beaumont Hospital, Dublin, Ireland
| | - Edel Duggan
- Department of Anaesthesia and Critical Care, Beaumont Hospital, Dublin, Ireland
| | - James O'Rourke
- Department of Anaesthesia and Critical Care, Beaumont Hospital, Dublin, Ireland
| | - Michael Moore
- Department of Anaesthesia and Critical Care, Beaumont Hospital, Dublin, Ireland
| | - Pedro Vasquez
- Department of Physiotherapy, Beaumont Hospital, Dublin, Ireland
| | - Orla Young
- Department of Otolaryngology - Head and Neck Surgery, Galway University Hospital, Galway, Ireland
| | - Thavakumar Subramaniam
- Department of Otolaryngology - Head and Neck Surgery, Galway University Hospital, Galway, Ireland
| | - Liam Skinner
- Department of Otolaryngology - Head and Neck Surgery, University Hospital Waterford, Waterford, Ireland
| | - Tom Moran
- Department of Otolaryngology - Head and Neck Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
- Department of Otolaryngology - Head and Neck Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - Fergal O'Duffy
- Department of Otolaryngology - Head and Neck Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
- Department of Otolaryngology - Head and Neck Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - Anthony Hennessy
- Department of Anaesthesiology, South Infirmary Victoria University Hospital, Cork, Ireland
| | - Andrew Dias
- Department of Otolaryngology - Head and Neck Surgery, South Infirmary Victoria University Hospital, Cork, Ireland
| | - Patrick Sheahan
- Department of Otolaryngology - Head and Neck Surgery, South Infirmary Victoria University Hospital, Cork, Ireland
- ENTO Research Unit, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Conall W R Fitzgerald
- Department of Otolaryngology - Head and Neck Surgery, St James's Hospital, Dublin, Ireland
| | - John Kinsella
- Department of Otolaryngology - Head and Neck Surgery, St James's Hospital, Dublin, Ireland
| | - Paul Lennon
- Department of Otolaryngology - Head and Neck Surgery, St James's Hospital, Dublin, Ireland
| | - Conrad V I Timon
- Department of Otolaryngology - Head and Neck Surgery, St James's Hospital, Dublin, Ireland
| | - Robbie S R Woods
- Department of Otolaryngology - Head and Neck Surgery, Beaumont Hospital, Dublin, Ireland
| | - Neville Shine
- Department of Otolaryngology - Head and Neck Surgery, Beaumont Hospital, Dublin, Ireland
| | - Gerard F Curley
- Department of Anaesthesia and Critical Care, Beaumont Hospital, Dublin, Ireland
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - James P O'Neill
- Department of Otolaryngology - Head and Neck Surgery, Beaumont Hospital, Dublin, Ireland
- Department of Otolaryngology - Head and Neck Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
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Malard O, Karakachoff M, Ferron C, Hans S, Vergez S, Garrel R, Gorphe P, Ramin L, Santini L, Villeneuve A, Lasne-Cardon A, Espitalier F, Hounkpatin A. Oncological and functional outcomes for transoral robotic surgery following previous radiation treatment for upper aerodigestive tract head and neck cancers. A French multicenter GETTEC group study. Cancer Med 2024; 13:e7031. [PMID: 38545809 PMCID: PMC10974718 DOI: 10.1002/cam4.7031] [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: 08/31/2023] [Revised: 01/11/2024] [Accepted: 02/09/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Transoral robotic surgery (TORS) opens new perspectives. We evaluated the outcomes for patients having undergone TORS after previous radiotherapy. METHODS A retrospective multicenter study (n = 138) in a previously irradiated area between 2009 and 2020. Survival was assessed with the Kaplan-Meier method. Prognostic factors were evaluated using a chi-squared test, Fisher's test, or Wilcoxon's test. RESULTS The median length of hospital stay was 12.5 days. Bleeding was the most frequent postoperative complication (15.2%, n = 22). Prophylactic vessel ligation did not significantly decrease bleeding. Complications were significantly lower for Tis, T1, and N0 tumors. 91.6% (n = 120) of the patients with a perioperative tracheotomy could be decannulated. Larynx was functional for 65.94% of the patients. The median length of follow-up was 26 months. The 5-year overall and relapse-free survival rates were respectively 59.9% and 43.4%. CONCLUSION Oncological and functional results confirmed the value of TORS as a treatment in previously irradiated area.
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Affiliation(s)
- Olivier Malard
- Department of Otolaryngology Head and Neck Surgery, Nantes University Hospital, Nantes, France
| | - Matilde Karakachoff
- Nantes Université, CHU Nantes, Pôle Hospitalo-Universitaire 11: Santé Publique, Clinique des données, INSERM, CIC 1413, Nantes, France
| | - Christophe Ferron
- Department of Otolaryngology Head and Neck Surgery, Nantes University Hospital, Nantes, France
| | - Stéphane Hans
- Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, Suresnes, France
| | - Sébastien Vergez
- Head and Neck Surgery Department, Cancer Institute Toulouse-Oncopole, Toulouse, France
| | - Renaud Garrel
- Department of Head and Neck Surgery, Montpellier Guy De Chauliac University Hospital, Montpellier, France
| | - Philippe Gorphe
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France
| | - Lionel Ramin
- Department of Head and Neck Surgery, Limoges Dupuytrens University Hospital, Limoges, France
| | - Laure Santini
- ENT-Head and Neck Surgery Department, La Conception University Hospital, Aix Marseille University, Marseille, France
| | - Alexandre Villeneuve
- Head and Neck Surgery Department, Georges-Pompidou European Hospital, Paris, France
| | - Audrey Lasne-Cardon
- Department of Head and Neck Surgery, François Baclesse Cancer center, Normandie University, Caen, France
| | - Florent Espitalier
- Department of Otolaryngology Head and Neck Surgery, Nantes University Hospital, Nantes, France
| | - Audrey Hounkpatin
- Department of Otolaryngology Head and Neck Surgery, Nantes University Hospital, Nantes, France
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Larsen MHH, Channir HI, Madsen AKØ, Rubek N, O'Leary P, Kjærgaard T, Kehlet H, von Buchwald C. The effect of dexamethasone on functional pain following Transoral Robotic Surgery: a randomized double blinded clinical trial. Acta Otolaryngol 2023; 143:894-901. [PMID: 37902607 DOI: 10.1080/00016489.2023.2269998] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 10/04/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND Pain is prevalent after most TransOral Robotic Surgery (TORS) procedures and may limit function i.e. swallowing. Currently, there is limited knowledge regarding optimal pain treatment in TORS. AIMS/OBJECTIVES This clinical trial randomized patients to either a high-dose dexamethasone or low-dose dexamethasone treatment in addition to a multimodal basic analgesic protocol. The aim of the trial was to investigate the pain intensity during rest and swallowing using the Visual Analogue Scale (VAS) after TORS lingual tonsillectomy. Secondary outcomes were acceptable food consistency, nausea, vomiting, opioid rescue usage, length of hospitalization, feeding tube placements, readmissions, blood glucose levels and postoperative complications. METHODS The trial was conducted between August 2020 and October 2022. Eligible patients were patients scheduled for TORS-L treatment of obstructive sleep apnea syndrome or as part of the diagnostic work-up of head and neck carcinoma of unknown primary. RESULTS Eighteen patients were and randomized 1:1. There were overall no significant differences between groups in the reported VAS scores during rest or swallowing (p ≥ .05). Overall, there were no differences in the secondary outcomes. CONCLUSION There were no differences in the pain intensity in the two treatment groups allocated to a basic multimodal analgesic package and either high-dose dexamethasone or low-dose dexamethasone treatment. The trial is the first RCT to include pain measurement during a procedure-relevant activity, thus creating a platform for future recovery studies.
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Affiliation(s)
- Mikkel Hjordt Holm Larsen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Hani Ibrahim Channir
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Anne Kathrine Østergaard Madsen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Niclas Rubek
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Padraig O'Leary
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas Kjærgaard
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Kehlet
- Section of Surgical Pathophysiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christian von Buchwald
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
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Larsen MHH, Channir HI, Madsen AKØ, Rubek N, O'Leary P, Kjærgaard T, Kehlet H, von Buchwald C. Why in hospital following transoral robotic lingual tonsillectomy? Acta Otolaryngol 2023; 143:796-800. [PMID: 37897327 DOI: 10.1080/00016489.2023.2265983] [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: 06/05/2023] [Accepted: 09/22/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND The reported hospital length of stay (LOS) following transoral robotic surgery lingual tonsillectomy (TORS-L) is variable, with limited understanding of the factors requiring hospitalization and no evidence-based criteria for discharge. AIMS/OBJECTIVES This observational cohort study investigated factors hindering discharge following TORS-L in a well-defined postoperative care program. METHODS Patients were included between August 2020 and October 2022. A discharge scheme was filled out twice daily, specifying the factor(s) for hospitalization among patients undergoing TORS-L. This trial was a sub-investigation of a national multicentre randomized clinical trial (RCT) testing the efficiency of high-dose dexamethasone on postoperative pain control. Participation in the RCT demanded admission to the fourth postoperative day as dexamethasone/placebo was given intravenously in repeated dosages till day 4 postoperatively. RESULTS Eighteen patients were included in the analysis. The main factor for hospitalization was nutritional difficulties, while pain was a limiting factor for discharge only on the first postoperative 1-3 days. More than half of the patients could have potentially been discharged on postoperative day 2 when omitting the RCT treatment plan in the analysis. CONCLUSION The study estimates that the majority of patients may be discharged on postoperative day 2 following TORS-L.
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Affiliation(s)
- Mikkel Hjordt Holm Larsen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Hani Ibrahim Channir
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Anne Kathrine Østergaard Madsen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Niclas Rubek
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Padraig O'Leary
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Aarhus University Hospital, Copenhagen, Denmark
| | - Thomas Kjærgaard
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Aarhus University Hospital, Copenhagen, Denmark
| | - Henrik Kehlet
- Section of Surgical Pathophysiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christian von Buchwald
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
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Sauer AB, Dowling EM, Bauman MM, Moore EJ, Carlson ML, Van Abel KM. Does surgical management still play a role in the management of ectopic lingual thyroid: Institutional experience and systematic review of the literature. Am J Otolaryngol 2022; 43:103461. [PMID: 35427937 DOI: 10.1016/j.amjoto.2022.103461] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/04/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Management of ectopic lingual thyroid (ELT) must balance the morbidity of disease with the morbidity of treatment. We investigate clinical outcomes associated with modern treatment options and analyze the role of transoral surgery in the treatment algorithm for ELT. METHODS This was a retrospective chart review of ELT patients treated at a tertiary care center from 1/1/1979 to 12/31/2019. In addition, a systematic review of the literature from 1979 to 2021 for reports of ELT was performed. Symptoms defined as high-risk were dysphagia, dysphonia, dyspnea, neck swelling, bleeding, and obstructive sleep apnea (OSA). RESULTS 36 patients within the institutional cohort (IC) and 224 cases in the systematic review (SRC) met criteria. The most common presenting symptoms for both cohorts were dysphagia, globus sensation, and dysphonia. One third of each cohort were hypothyroid, while 3% (n = 1) and 9% (n = 21) of the IC and SRC, respectively, had clinical suspicion of malignancy at presentation. 27% (n = 10) of the IC and 55% (n = 121) of the SRC underwent surgical therapy. There was a 4% (3/72) transoral bleed rate for all patients undergoing transoral surgery. Other reported complications were minor. There were no tracheostomies, and no deaths. Among observed, medically treated, and surgically treated patients, symptoms improved during follow up for 43% or 68% in the IC and SRC, respectively. Following surgery, symptoms improved or resolved for 86% or 93% in the IC and SRC, respectively. CONCLUSIONS Asymptomatic ELTs with no concern for malignancy can be managed with observation. Patients with mild symptoms or hypothyroidism may trial thyroid suppressive therapy or RAI. RAI can be considered for patients with high-risk symptoms. For patients with symptoms resistant to conservative therapy, concern for malignancy or high-risk symptoms not conducive to RAI, surgery should be considered. Transoral approaches offer acceptable morbidity, and most patients experience resolution of symptoms following this approach.
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Sarna K, Sonigra KJ, Amuti T, Kamau M, Ngeow WC, Mandela Idenya P. The Journey of the Lingual Artery from the Neck to the Oral Cavity: A Cadaveric Study. Craniomaxillofac Trauma Reconstr 2022; 15:39-45. [PMID: 35265276 PMCID: PMC8899351 DOI: 10.1177/19433875211002058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Study Design Descriptive cross-sectional. Objective The origin of the lingual artery (LA) has been well studied due to its implication in neck dissection, but the course thereafter to the oral cavity is less described. This cadaveric study traced the journey of the LA from the external carotid artery to its terminal branches in the tongue. Methods Following bilateral neck dissections in 35 black Kenyan cadavers, the incidence of Beclard's, Lesser's and Pirogoff's triangles, the types of LA origin with its length, relationship to the hyoglossus muscle and anastomosis with other vessels were documented. Results Beclard's triangle was found in 64 dissections (91.42%), Lesser's in 46 dissections (65.71%) and Pirogoff's in 39 dissections (55.71%). The LA presented either as a solitary branch (67.15%) or as a branch of either the linguofacial (LFT-24.29%), thyrolingual (TLT-2.72%) or thyrolinguofacial (TLFT-2.86%) trunk. The solitary LA was the longest at 6.93 mm, followed by the TLT branch (6.58 mm), LFT branch (6.12 mm) and TLFT branch (5.65 mm). The majority of solitary LA and LA branches of LFT and TLFT passed through the hyoglossus, while all LA branches of the TLT coursed medial to the muscle. All variants of LA have been found to anastomose with the submental artery (SMA) at frequencies that ranged from 11.10% to 100%. Conclusions The LA was found in all cadavers and all Beclards' triangles. There is a significant incidence of LFT and TLFT variants in the Kenyan population. The LA passed either through or medial to the hyoglossus with no lateral relationship being observed.
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Affiliation(s)
- Krishan Sarna
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya,Krishan Sarna, BSc, Department of Human Anatomy, University of Nairobi, P.O. Box 30197-00100, Nairobi, Kenya.
| | | | - Thomas Amuti
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya
| | - Martin Kamau
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya
| | - Wei Cheong Ngeow
- Department of Oral & Maxillofacial Clinical Sciences, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia
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Poissonnet V, Chabrillac E, Schultz P, Morinière S, Gorphe P, Baujat B, Garrel R, Lasne-Cardon A, Villeneuve A, Chambon G, Fakhry N, Aubry K, Dufour X, Malard O, Mastronicola R, Vairel B, Gallet P, Ceruse P, Jegoux F, Ton Van J, De Bonnecaze G, Vergez S. Airway management during transoral robotic surgery for head and neck cancers: a French GETTEC group survey. Eur Arch Otorhinolaryngol 2022; 279:3619-3627. [DOI: 10.1007/s00405-021-07188-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 11/15/2021] [Indexed: 11/03/2022]
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Wu X, Pastel DA, Khan R, Eskey CJ, Shi Y, Sramek M, Paydarfar JA, Halter RJ. Quantifying Tumor and Vasculature Deformations during Laryngoscopy. Ann Biomed Eng 2022; 50:94-107. [PMID: 34993696 PMCID: PMC9035291 DOI: 10.1007/s10439-021-02896-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 11/17/2021] [Indexed: 01/09/2023]
Abstract
Retractors and scopes used in head and neck surgery to provide adequate surgical exposure also deform critical structures in the region. Surgeons typically use preoperative imaging to plan and guide their tumor resections, however the large tissue deformation resulting from placement of retractors and scopes reduces the utility of preoperative imaging as a reliable roadmap. We quantify the extent of tumor and vasculature deformation in patients with tumors of the larynx and pharynx undergoing diagnostic laryngoscopy. A mean tumor displacement of 1.02 cm was observed between the patients' pre- and intra-operative states. Mean vasculature displacement at key bifurcation points was 0.99 cm. Registration to the hyoid bone can reduce tumor displacement to 0.67 cm and improve carotid stem angle deviations but increase overall vasculature displacement. The large deformation results suggest limitations in reliance on preoperative imaging and that using specific landmarks intraoperatively or having more intraoperative information could help to compensate for these deviations and ultimately improve surgical success.
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Affiliation(s)
- Xiaotian Wu
- Gordon Center for Medical Imaging at Massachusetts General Hospital and Harvard Medical School, 13 St, CNY149-5212, Charlestown, MA 02129
| | - David A. Pastel
- Department of Radiology, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr., Lebanon, NH 03756,Geisel School of Medicine at Dartmouth College, 1 Rope Ferry Rd., Hanover, NH 03755
| | - Rihan Khan
- Department of Radiology, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr., Lebanon, NH 03756,Geisel School of Medicine at Dartmouth College, 1 Rope Ferry Rd., Hanover, NH 03755
| | - Clifford J. Eskey
- Department of Radiology, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr., Lebanon, NH 03756,Geisel School of Medicine at Dartmouth College, 1 Rope Ferry Rd., Hanover, NH 03755
| | - Yuan Shi
- Thayer School of Engineering at Dartmouth College, 14 Engineering Dr., Hanover, NH 03755
| | - Michael Sramek
- Geisel School of Medicine at Dartmouth College, 1 Rope Ferry Rd., Hanover, NH 03755
| | - Joseph A. Paydarfar
- Geisel School of Medicine at Dartmouth College, 1 Rope Ferry Rd., Hanover, NH 03755,Thayer School of Engineering at Dartmouth College, 14 Engineering Dr., Hanover, NH 03755,Section of Otolaryngology, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr., Lebanon, NH 03756
| | - Ryan J. Halter
- Geisel School of Medicine at Dartmouth College, 1 Rope Ferry Rd., Hanover, NH 03755,Thayer School of Engineering at Dartmouth College, 14 Engineering Dr., Hanover, NH 03755
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Vianini M, Fiacchini G, Benettini G, Dallan I, Bruschini L. Experience in Transoral Robotic Surgery in Pediatric Subjects: A Systematic Literature Review. Front Surg 2021; 8:726739. [PMID: 34458318 PMCID: PMC8387868 DOI: 10.3389/fsurg.2021.726739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 07/19/2021] [Indexed: 02/03/2023] Open
Abstract
Pediatric transoral robotic surgery (TORS) has improved from 2007 to 2020, widening its indications and feasibility. This article aims to systematically analyze the procedures performed from the first use until the current year, observing their evolution over time. A systematic literature review was performed using PubMed, Scopus, Web of Science, and Cochrane databases between March 1, 2000, and April 1, 2020. We selected studies that were written only in English and were performed in live human subjects. About 16 studies were found with a total of 73 subjects treated, among them 41 were men and 32 were women with an average age of 6.8 ± 4.99 years. There have been four (5.47%) conversions. Both functional and benign-malignant diseases have been treated in the series. Eleven (15.06%) pre-operative tracheostomy and zero post-operative tracheostomy were performed. The bleeding data was only reported in 9 studies and was <50 ml. Only one (1.36%) intra-operative complication and 10 (12.32%) postoperative complications were reported. We consider the TORS procedures in pediatric subjects safe, feasible and with good surgical outcomes up to the laryngeal region.
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Affiliation(s)
- Matteo Vianini
- Otolaryngology, Audiology and Phoniatric Operative, Department of Surgical Pathology, Medical, Molecular and Critical Area, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Giacomo Fiacchini
- Otolaryngology, Audiology and Phoniatric Operative, Department of Surgical Pathology, Medical, Molecular and Critical Area, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Giacomo Benettini
- Otolaryngology, Audiology and Phoniatric Operative, Department of Surgical Pathology, Medical, Molecular and Critical Area, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Iacopo Dallan
- Otolaryngology, Audiology and Phoniatric Operative, Department of Surgical Pathology, Medical, Molecular and Critical Area, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Luca Bruschini
- Otolaryngology, Audiology and Phoniatric Operative, Department of Surgical Pathology, Medical, Molecular and Critical Area, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
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Dunlap Q, Mitchell WM, Gardner JR, King D, Samant R, Moreno M, Vural E. Vascularity Outcomes of Lingual Artery Ligation in Transoral Robotic Base of Tongue Resections. Otolaryngol Head Neck Surg 2021; 166:684-687. [PMID: 34098802 DOI: 10.1177/01945998211017446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To explore the effect of lingual artery ligation on tongue vascularity, we performed an analysis of 25 patients who underwent transoral robotic surgery for base of tongue cancers (May 2011 to December 2019). Hounsfield units of the intrinsic muscles (IMs) and genioglossus muscles (GGs) were measured in postoperative imaging (mean 4 months) as a surrogate for vascularity. In ligated patients (n = 15), the values from the ligated/resected side of the tongue were compared with the contralateral side and the nonligated side of resection. Individually, IMs and GGs on the ligated side demonstrated no significant difference to the contralateral side (P = .662 and .618, respectively). Ligation produced a significant decrease in IM measurements but no difference between GG values vs nonligated patients (P = .050 and .818, respectively). No difference was appreciated in mean values for combined IMs and GGs between cohorts (P = .212). No gross tongue atrophy or complications were incurred. Future studies are warranted to delineate long-term effects.
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Affiliation(s)
- Quinn Dunlap
- Department of Otolaryngology-Head and Neck Surgery, Division of Head and Neck Oncology and Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - William M Mitchell
- Department of Otolaryngology-Head and Neck Surgery, Division of Head and Neck Oncology and Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - James Reed Gardner
- Department of Otolaryngology-Head and Neck Surgery, Division of Head and Neck Oncology and Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Deanne King
- Department of Otolaryngology-Head and Neck Surgery, Division of Head and Neck Oncology and Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Rohan Samant
- Department of Diagnostic and Interventional Radiology, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Mauricio Moreno
- Department of Otolaryngology-Head and Neck Surgery, Division of Head and Neck Oncology and Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Emre Vural
- Department of Otolaryngology-Head and Neck Surgery, Division of Head and Neck Oncology and Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Nair S, Vijay DM, Venkatakarthikeyan C. Transoral robotic surgery for angiomyxoma of upper alveolus. Natl J Maxillofac Surg 2021; 12:116-119. [PMID: 34188413 PMCID: PMC8191561 DOI: 10.4103/njms.njms_116_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 12/24/2020] [Accepted: 02/08/2021] [Indexed: 11/21/2022] Open
Abstract
Angiomyxomas are benign, slow-growing mesenchymal tumors. Intraoral angiomyxoma are extremely rare with very few reported cases in the existing literature. The primary line of management is surgical resection with a long-term follow-up, due to their tendency to recur. Here, we report a rare case of angiomyxoma of the upper alveolus eroding the hard palate and extending into the maxillary antrum, in a middle-aged male. Transoral robotic surgery (TORS) was performed due to the nature of the tumor (bulky benign lesion with bony erosion), inaccessibility and poor visualization of the superior extent of the tumor. The three-dimensional endoscopic camera and flexible robotic arms allowed easy dissection around the tumor margins and en bloc resection of the tumor. The patient had a smooth recovery with the best possible functional outcome. This is the first case of robot-assisted excision of a large benign oral tumor with superior extension through erosion of the palate and can be included as an extended indication of TORS.
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Affiliation(s)
- Swati Nair
- Department of Otorhinolaryngology and Head and Neck Surgery, Apollo Main Hospital, Chennai, Tamil Nadu, India
| | - Deepika M Vijay
- Department of Otorhinolaryngology and Head and Neck Surgery, Apollo Main Hospital, Chennai, Tamil Nadu, India
| | - C Venkatakarthikeyan
- Department of Otorhinolaryngology and Head and Neck Surgery, Apollo Main Hospital, Chennai, Tamil Nadu, India
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12
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Gualtieri T, Verzeletti V, Ferrari M, Perotti P, Morello R, Taboni S, Palumbo G, Ravanelli M, Rampinelli V, Mattavelli D, Paderno A, Buffoli B, Rodella LF, Nicolai P, Deganello A. A new landmark for lingual artery identification during transoral surgery: Anatomic-radiologic study. Head Neck 2021; 43:1487-1498. [PMID: 33496052 DOI: 10.1002/hed.26606] [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: 06/20/2020] [Revised: 12/02/2020] [Accepted: 12/30/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND A landmark for the identification of the lingual artery (LA) through a transoral perspective can provide surgeons with an easy method to prevent and manage intraoperative bleeding during transoral approach to the base of tongue (BOT). METHODS Thirteen tongue and five head and neck specimens were dissected to identify and assess the reliability of the lingual point (LP) as a new landmark for the LA at BOT. The pathway of 42 LAs was radiologically evaluated; axial depth and vertical offset were measured for each LA. RESULTS Dissection study: a description of LP is provided; the LA was easily identified in all specimens (36/36 sides) using LP as a landmark. Radiologic study: the mean depth of the LA was 4.2 mm, the mean vertical offset was 1.3 mm. CONCLUSIONS LP is a simple and reliable landmark for identification of the LA, potentially helping surgeons to prevent and manage intraoperative bleeding.
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Affiliation(s)
- Tommaso Gualtieri
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Vincenzo Verzeletti
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.,Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Marco Ferrari
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.,Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy
| | - Pietro Perotti
- Department of Otorhinolaryngology - Head and Neck Surgery, "S. Chiara" Hospital, Azienda Provinciale Per I Servizi Sanitari (APSS), Trento, Italy
| | - Riccardo Morello
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Surgical Specialties, ASST Cremona - Ospedale di Cremona, Cremona, Italy
| | - Stefano Taboni
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.,Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy
| | - Giovanni Palumbo
- Unit of Radiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Marco Ravanelli
- Unit of Radiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Vittorio Rampinelli
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Davide Mattavelli
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Alberto Paderno
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Barbara Buffoli
- Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Luigi Fabrizio Rodella
- Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Piero Nicolai
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy
| | - Alberto Deganello
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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13
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Sandelski MM, Drejet SM, Zimmer D, Yesensky JA, Moore M, Mantravadi AV, Sim MW. Evaluating the risks and benefits of ketorolac in transoral robotic surgery. J Robot Surg 2021; 15:885-889. [PMID: 33453022 DOI: 10.1007/s11701-021-01190-y] [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: 11/21/2020] [Accepted: 01/07/2021] [Indexed: 10/22/2022]
Abstract
Transoral Robotic Surgery (TORS) is increasingly used for oropharyngeal neoplasms and obstructive sleep apnea. Post-operative pain and bleeding remain concerns. Ketorolac has proved to be a safe alternative or addition to narcotics in other operations, but has not been thoroughly evaluated in TORS. A retrospective review was carried out on all TORS cases at our institution between April 2012 and March 2019, with the vast majority of cases performed starting in 2017. Post-operative bleed rates were compared between those who received Ketorolac and those who did not. Secondary outcomes evaluated included post-operative pain scores and need for feeding tube upon discharge. A total of 81 TORS cases were evaluated, with 37 patients receiving Ketorolac. Six (7.4%) patients reported post-operative bleeding, with one major and five minor bleeds. The patient with major bleeding requiring operative intervention did not receive Ketorolac. All five patients with minor bleeding received Ketorolac, but no bleeds occurred in the immediate post-operative setting while receiving Ketorolac. The average time of bleeding was 8 days post-operative. There were no significant differences in pain scores or time to feeding tube removal. This preliminary study shows that Ketorolac use in the postoperative pain management after TORS does not increase major bleeding risk without benefits in pain management. There was increased risk of minor bleeding not requiring intervention, but this was not significant. Future prospective studies are needed to determine if it improves pain and swallowing and decreases narcotic requirements following TORS.
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Affiliation(s)
| | - Sarah M Drejet
- Department of Otolaryngology, Head and Neck Surgery, Indiana University School of Medicine, 1130 W. Michigan Street, Suite 400, Indianapolis, IN, 46202, USA
| | - David Zimmer
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jessica A Yesensky
- Department of Otolaryngology, Head and Neck Surgery, Indiana University School of Medicine, 1130 W. Michigan Street, Suite 400, Indianapolis, IN, 46202, USA
| | - Michael Moore
- Department of Otolaryngology, Head and Neck Surgery, Indiana University School of Medicine, 1130 W. Michigan Street, Suite 400, Indianapolis, IN, 46202, USA
| | - Avinash V Mantravadi
- Department of Otolaryngology, Head and Neck Surgery, Indiana University School of Medicine, 1130 W. Michigan Street, Suite 400, Indianapolis, IN, 46202, USA
| | - Michael W Sim
- Department of Otolaryngology, Head and Neck Surgery, Indiana University School of Medicine, 1130 W. Michigan Street, Suite 400, Indianapolis, IN, 46202, USA.
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14
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Sethi RK, Chen MM, Malloy KM. Complications of Transoral Robotic Surgery. Otolaryngol Clin North Am 2020; 53:1109-1115. [DOI: 10.1016/j.otc.2020.07.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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15
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Sharbel DD, Abkemeier M, Sullivan J, Zimmerman Z, Albergotti WG, Duvvuri U, Byrd JK. Transcervical arterial ligation for prevention of postoperative hemorrhage in transoral oropharyngectomy: Systematic review and meta-analysis. Head Neck 2020; 43:334-344. [PMID: 32974970 DOI: 10.1002/hed.26480] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 03/23/2020] [Accepted: 09/11/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Transcervical arterial ligation has been studied as a useful procedure to prevent bleeding events after transoral robotic surgery (TORS). METHODS A systematic review of English-language literature on arterial ligation in TORS from 2005 to 2019 was conducted using Cochrane, PubMed, Web of Science (WoS), and ScienceDirect databases. Studies evaluating ligation and rates of postoperative hemorrhage were included. Meta-analysis of included studies was performed to assess impact of ligation on postoperative hemorrhage. RESULTS Five studies with 2008 patients were included. History of radiation (odds ratio [OR] = 2.26, P = .02) and advanced tumor stage (OR = 1.93, P = .02) were found to predispose patients to postoperative hemorrhage. Arterial ligation was protective against severe hemorrhage in the mixed primary surgical modality cohort (OR = 0.33, P = .03) and in the TORS-only subgroup (OR = 0.21, P = .02), but did not significantly impact overall odds of postoperative hemorrhage. CONCLUSION Transcervical arterial ligation offers protection against major/severe postoperative hemorrhage in patients undergoing TORS. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Daniel D Sharbel
- Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Mary Abkemeier
- Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - James Sullivan
- Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Zach Zimmerman
- Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - William G Albergotti
- Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Umamaheswar Duvvuri
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - James Kenneth Byrd
- Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
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16
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Abstract
There are numerous salivary gland pathologies for which robotic surgery can provide benefit. This article reviews the primary indications for use of transoral robotic surgery for salivary gland neoplasms. It also discusses transoral and retroauricular robotic approaches for pathology of the submandibular gland and prestyloid parapharyngeal space. These approaches have the advantage of avoiding a visible scar and are additionally minimally invasive in other ways as well. Robotic surgery offers advantages in several different modules of salivary gland surgery, similar to those it offers for oropharyngeal cancer, including improved optics, manual dexterity, and teamwork.
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17
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Outcomes of transoral laser microsurgery and transoral robotic surgery in oropharyngeal squamous cell carcinoma. Auris Nasus Larynx 2020; 48:295-301. [PMID: 32883577 DOI: 10.1016/j.anl.2020.08.019] [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: 06/29/2020] [Revised: 08/14/2020] [Accepted: 08/19/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Transoral robotic surgery (TORS) has evolved to a standard therapy modality for oropharyngeal carcinoma, especially in T1/ T2 tumors involving the base of the tongue due to its advantages compared with open surgery. However, knowledge about its benefits compared with transoral laser microsurgery (TLM) are scarce. This study compares oncological and functional results of TLM or TORS in the treatment of oropharyngeal squamous cell carcinoma (OPSCC). METHODS This retrospective analysis comprises all patients with OPSCC treated with TLM (n = 30) or TORS (n = 24) between April 2003 and May 2018 (follow-up 43 ± 38.3 months). Both treatment groups (TLM and TORS) were comparable in terms of the stage of the disease, prognosis-determining factors, and adjuvant therapy modalities. RESULTS There were no significant differences regarding to the resection status (p = 0.272), the rate of local- (p = 0.834) and distant- recurrence (p = 0.416), with a disease-free survival of 86.7 % and 87.5 %, respectively (p = 0.892). In addition, we could not confirm any differences regarding to operating time (p = 0.860), intraoperative blood loss (p = 0.660), inpatient stay (p = 0.585) and postoperative bleeding rate (p = 0.245). The frequency of tracheostomy and percutaneous endoscopic gastrostomy between both groups is comparable, with a longer duration of tube feeding in patients who have received TLM (p = 0.030). CONCLUSION In conclusion, TORS allows for similar oncological outcomes compared with TLM at comparable perioperative risks. The postoperative swallowing function may benefit from TORS.
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18
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Bobian M, Gupta A, Graboyes EM. Acute Pain Management Following Head and Neck Surgery. Otolaryngol Clin North Am 2020; 53:753-764. [PMID: 32682530 DOI: 10.1016/j.otc.2020.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Acute pain management following major head and neck (HN) surgery is complex. Multimodal analgesia (MMA) regimens including acetaminophen, nonsteroidal anti-inflammatory drugs, gabapentinoids, and locoregional anesthetics are safe and effective in this population (including patients undergoing HN free flap surgery). Special considerations for patients undergoing HN free flap surgery include judicious use of steroids and attention to donor site pain. Evidence for specific analgesic regimens following transoral robotic surgery is limited but should include MMA and perioperative dexamethasone. Further study is required to optimize combinations, dosages, and duration of perioperative analgesia medications, opioid and nonopioid, for patients undergoing major HN surgery.
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Affiliation(s)
- Michael Bobian
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC 29425, USA
| | - Annika Gupta
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC 29425, USA
| | - Evan M Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC 29425, USA.
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19
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Changing paradigms in the treatment of residual/recurrent head and neck cancer: implications for dysphagia management. Curr Opin Otolaryngol Head Neck Surg 2020; 28:165-171. [DOI: 10.1097/moo.0000000000000620] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Bollig CA, Gilley DR, Ahmad J, Jorgensen JB. Prophylactic arterial ligation following transoral robotic surgery: A systematic review and meta‐analysis. Head Neck 2020; 42:739-746. [DOI: 10.1002/hed.26020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 09/27/2019] [Accepted: 11/06/2019] [Indexed: 02/03/2023] Open
Affiliation(s)
- Craig A. Bollig
- Department of Otolaryngology—Head and Neck SurgeryWashington University School of Medicine St. Louis Missouri
| | - David R. Gilley
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Missouri School of Medicine Columbia Missouri
| | - Jumah Ahmad
- University of Missouri School of Medicine Columbia Missouri
| | - Jeffrey B. Jorgensen
- Department of Otolaryngology—HNS and Communicative DisordersUniversity of Louisville School of Medicine Louisville Kentucky
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21
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Van Abel KM, Yin LX, Price DL, Janus JR, Kasperbauer JL, Moore EJ. One‐year outcomes for da Vinci single port robot for transoral robotic surgery. Head Neck 2020; 42:2077-2087. [DOI: 10.1002/hed.26143] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 01/27/2020] [Accepted: 03/05/2020] [Indexed: 01/29/2023] Open
Affiliation(s)
- Kathryn M. Van Abel
- Department of Otolaryngology‐Head and Neck SurgeryMayo Clinic School of Medicine Rochester Minnesota USA
| | - Linda X. Yin
- Department of Otolaryngology‐Head and Neck SurgeryMayo Clinic School of Medicine Rochester Minnesota USA
| | - Daniel L. Price
- Department of Otolaryngology‐Head and Neck SurgeryMayo Clinic School of Medicine Rochester Minnesota USA
| | - Jeffery R. Janus
- Department of Otolaryngology‐Head and Neck SurgeryMayo Clinic School of Medicine Rochester Minnesota USA
| | - Jan L. Kasperbauer
- Department of Otolaryngology‐Head and Neck SurgeryMayo Clinic School of Medicine Rochester Minnesota USA
| | - Eric J. Moore
- Department of Otolaryngology‐Head and Neck SurgeryMayo Clinic School of Medicine Rochester Minnesota USA
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22
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Stokes W, Ramadan J, Lawson G, Ferris FRL, Holsinger FC, Turner MT. Bleeding Complications After Transoral Robotic Surgery: A Meta-Analysis and Systematic Review. Laryngoscope 2020; 131:95-105. [PMID: 32108347 DOI: 10.1002/lary.28580] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 01/21/2020] [Accepted: 01/24/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Postoperative hemorrhage is the most common complication of transoral robotic surgery (TORS), the severity of which can range from minor bleeding treated with observation to catastrophic hemorrhage leading to death. To date, little is known about the incidence, risk factors, and management of post-TORS hemorrhage. STUDY DESIGN Systematic Review and Metanlysis. METHODS A systematic review of the published literature using the Cochrane Handbook for Systematic Reviews of Interventions was performed and examined TORS, postoperative hemorrhage, and the use of prophylactic transcervical arterial ligation (TAL). RESULTS A total of 13 articles were included in the analysis. To date, there have been 332 cases of hemorrhage following a total of 5748 TORS. The pooled median post-TORS hemorrhage rate was 6.47%. The overall incidence of minor and major hemorrhage was 5.29% and 2.90%. Patients with prior radiation (relative risk [RR] = 1.46, 95% confidence interval [CI] = 1.00-2.12), large tumors (RR = 2.11, 95% CI = 1.48-2.99), and those requiring perioperative coagulation (RR = 2.25, 95% CI = 1.54-3.28) had significantly higher relative risks of hemorrhage. There was no significant difference in the relative risk of overall hemorrhage with TAL. Looking at major hemorrhage, patients undergoing TAL had a large but insignificant relative risk reduction in post-TORS hemorrhage (RR = 0.40, 95% CI = 0.15-1.07). CONCLUSION The incidence of post-TORS hemorrhage is low (5.78%), and for major hemorrhage requiring emergent embolization, TAL, or tracheotomy to control hemorrhage it is even lower (2.90%). Large tumors, perioperative anticoagulation, and prior radiation were associated with significantly increased risk of post-TORS hemorrhage. TAL does not reduce the overall incidence of post-TORS hemorrhage but may lead to fewer severe hemorrhages. LEVEL OF EVIDENCE III Laryngoscope, 131:95-105, 2021.
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Affiliation(s)
- William Stokes
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University Health Sciences Center, Morgantown, West Virginia
| | - Jad Ramadan
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University Health Sciences Center, Morgantown, West Virginia
| | - Georges Lawson
- Department of Otolaryngology-Head and Neck Surgery, Université Catholique de Louvain Centre Hospitalier Universitaire de Mont-Godinne, Yvoir, Belgium
| | - F Robert L Ferris
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Department of Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Floyd Christopher Holsinger
- Division of Head and Neck Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University Medical Center, Palo Alto, California
| | - Meghan T Turner
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University Health Sciences Center, Morgantown, West Virginia
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23
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Kwan BY, Khan NM, Almeida JR, Goldstein D, Paleri V, Forghani R, Yu E. Transoral robotic surgery for head and neck malignancies: Imaging features in presurgical workup. Head Neck 2019; 41:4018-4025. [DOI: 10.1002/hed.25887] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 07/01/2019] [Accepted: 07/11/2019] [Indexed: 12/14/2022] Open
Affiliation(s)
- Benjamin Y.M. Kwan
- Department of RadiologyQueen's University Kingston Ontario Canada
- Princess Margaret Cancer CenterUniversity of Toronto Toronto Ontario Canada
| | | | - John R. Almeida
- Princess Margaret Cancer CenterUniversity of Toronto Toronto Ontario Canada
| | - David Goldstein
- Princess Margaret Cancer CenterUniversity of Toronto Toronto Ontario Canada
| | - Vinidh Paleri
- Head and Neck UnitRoyal Marsden NHS Hospital London UK
| | - Reza Forghani
- Department of RadiologyMcGill University Montreal Quebec Canada
| | - Eugene Yu
- Princess Margaret Cancer CenterUniversity of Toronto Toronto Ontario Canada
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24
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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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25
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Li H, Torabi SJ, Park HS, Yarbrough WG, Mehra S, Choi R, Judson BL. Clinical value of transoral robotic surgery: Nationwide results from the first 5 years of adoption. Laryngoscope 2018; 129:1844-1855. [DOI: 10.1002/lary.27740] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Hong Li
- Yale University School of Medicine; New Haven Connecticut U.S.A
- Department of Surgery, Section of Otolaryngology; Yale University School of Medicine; New Haven Connecticut U.S.A
| | - Sina J. Torabi
- Yale University School of Medicine; New Haven Connecticut U.S.A
- Department of Surgery, Section of Otolaryngology; Yale University School of Medicine; New Haven Connecticut U.S.A
| | - Henry S. Park
- Yale University School of Medicine; New Haven Connecticut U.S.A
- Yale Cancer Center; New Haven Connecticut U.S.A
- Department of Therapeutic Radiology; Yale School of Medicine; New Haven Connecticut U.S.A
| | - Wendell G. Yarbrough
- Yale University School of Medicine; New Haven Connecticut U.S.A
- Department of Surgery, Section of Otolaryngology; Yale University School of Medicine; New Haven Connecticut U.S.A
- Yale Cancer Center; New Haven Connecticut U.S.A
| | - Saral Mehra
- Yale University School of Medicine; New Haven Connecticut U.S.A
- Department of Surgery, Section of Otolaryngology; Yale University School of Medicine; New Haven Connecticut U.S.A
- Yale Cancer Center; New Haven Connecticut U.S.A
| | - Rachel Choi
- Yale University School of Medicine; New Haven Connecticut U.S.A
- Department of Surgery, Section of Otolaryngology; Yale University School of Medicine; New Haven Connecticut U.S.A
| | - Benjamin L. Judson
- Yale University School of Medicine; New Haven Connecticut U.S.A
- Department of Surgery, Section of Otolaryngology; Yale University School of Medicine; New Haven Connecticut U.S.A
- Yale Cancer Center; New Haven Connecticut U.S.A
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