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Hans S, Baudouin R, Circiu MP, Couineau F, Rigal T, Remacle MJ, De Vito A, Cammaroto G, Crevier-Buchman L, Lechien JR. One hundred fifty years of total laryngectomies. Front Oncol 2024; 14:1351549. [PMID: 38915362 PMCID: PMC11194346 DOI: 10.3389/fonc.2024.1351549] [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: 12/06/2023] [Accepted: 04/15/2024] [Indexed: 06/26/2024] Open
Abstract
The inaugural total laryngectomy in history was conducted by Billroth in 1873. Nevertheless, significant enhancements to the technique were achieved through the contributions of Gluck, Sorensen, and various other surgeons. Throughout the twentieth century, advancements in anesthesia, infectious disease, hospital hygiene, antibiotic therapy, resuscitation, and the expertise of numerous laryngologists elevated total laryngectomy to a pivotal surgical intervention in head and neck surgery. The latter half of the twentieth century witnessed a paradigm shift with the emergence of organ preservation protocols. Total laryngectomy became the preferred choice for patients experiencing radiotherapy failure. However, the widespread use of laryngeal conservative treatments appears to be correlated with a decline in overall survival rates in the United States and Europe. The evolution of new minimally invasive surgical approaches in the twenty-first century may usher in a revolutionary era in the management of laryngeal carcinoma, offering the potential for improved survival and functional outcomes.
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Affiliation(s)
- Stéphane Hans
- Research Committee of the Young Otolaryngologists of the International Federation of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Robin Baudouin
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Marta P. Circiu
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Florent Couineau
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Tiffany Rigal
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Marc J. Remacle
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Andrea De Vito
- Department of Otolaryngology-Head and Neck Surgery, Forlì & Faenza Hospitals Ravenna & Lugo Hospitals, Health Local Agency of Romagna, Forli, Italy
| | - Giovanni Cammaroto
- Research Committee of the Young Otolaryngologists of the International Federation of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France
- Department of Otolaryngology-Head and Neck Surgery, Forlì & Faenza Hospitals Ravenna & Lugo Hospitals, Health Local Agency of Romagna, Forli, Italy
| | - Lise Crevier-Buchman
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Jérôme R. Lechien
- Research Committee of the Young Otolaryngologists of the International Federation of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
- Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, University of Mons (UMONS) Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium
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Tumlin P, Dugan B, Hassid S, Lawson G, Turner M. Robotic and endoscopic trans-oral total laryngectomy, a systematic review and meta-analysis. J Robot Surg 2024; 18:214. [PMID: 38758418 DOI: 10.1007/s11701-024-01970-2] [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: 03/11/2024] [Accepted: 05/03/2024] [Indexed: 05/18/2024]
Abstract
Trans-oral total laryngectomy (TOTL) is a novel minimally invasive approach to narrow-field laryngectomy. The objective of this study was to review published data on robotic and endoscopic-assisted TOTL to examine oncologic, functional, and adverse outcomes. MEDLINE, Web of Science, and Cochrane databases were searched between January 2009 and December 2023. PRISMA guidelines were used for data abstraction independently by two reviewers. Proportional meta-analysis (random effects model) was used for analysis. Main outcomes included oncologic outcomes (margin status, recurrence rate) and surgical complications (fistula, hemorrhage, need for second operation). Eight studies were included (total of 37 patients). Cases included 31 robotic-assisted, 3 endoscopic-assisted, and 3 robotic cases which required conversion to open approach. Most cases were performed for laryngeal SCC (22 patients, 59.5%). Primary closure was achieved in all patients. Negative margins were achieved in 20 of 21 patients with LSCC. Recurrence data was reported in 20 LSCC patients with disease recurrence in 4 patients (20%). Follow-up was described for 15 patients (mean of 3.5 years, range 1.6-5.8 years). Eleven complications occurred including fistula, bleed, and stomal stenosis with a pooled rate of 33.7% (95% CI: 16.4-53.0%, I2 = 0). Six fistulas occurred with a pooled rate of 23.2% (95% CI: 5.8-45.4%, I2 = 0). TOTL is an emerging treatment modality appropriate for select patients requiring TL and offers a minimally invasive approach with less tissue disruption. This is the first systematic review and meta-analysis to examine its oncologic outcomes and complications. Larger case series with adequate follow-up are needed to better characterize TOTL outcomes.
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Affiliation(s)
- Parker Tumlin
- Department of Otolaryngology, West Virginia University, One Medical Center Dr, Morgantown, WV, 26508, USA.
| | - Bradford Dugan
- Department of Otolaryngology, West Virginia University, One Medical Center Dr, Morgantown, WV, 26508, USA
| | - Samantha Hassid
- Université Catholique de Louvain, Centre Hospitalier Universitaire de Mont-Godinne, Yvoir, Belgium
| | - Georges Lawson
- Université Catholique de Louvain, Centre Hospitalier Universitaire de Mont-Godinne, Yvoir, Belgium
| | - Meghan Turner
- Department of Otolaryngology, West Virginia University, One Medical Center Dr, Morgantown, WV, 26508, USA
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Abstract
Transoral robotic surgery (TORS) is a growing field in the treatment of head and neck cancers. Its benefits have been proven in the treatment of oropharynx HPV-positive squamous cell carcinoma, replacing chemoradiation as primary treatment of early-stage cancers or reducing the required radiation dosage, leading to improved functional outcomes without compromising oncological outcomes. There is also interest in the application of TORS for larynx cancer with the hope of achieving similar outcomes to replace open surgery or radiation treatments. Specifically, in the larynx, TORS can be used to resect supraglottic or glottic tumors.
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Mella MH, Chabrillac E, Dupret-Bories A, Mirallie M, Vergez S. Transoral Robotic Surgery for Head and Neck Cancer: Advances and Residual Knowledge Gaps. J Clin Med 2023; 12:jcm12062303. [PMID: 36983308 PMCID: PMC10056198 DOI: 10.3390/jcm12062303] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 03/11/2023] [Accepted: 03/14/2023] [Indexed: 03/17/2023] Open
Abstract
Minimally invasive surgery is a growing field in surgical oncology. After acquiring its first Food and Drug Administration approval in 2009 for T1–T2 malignancies of the oral cavity, oropharynx, and larynx, transoral robotic surgery (TORS) has gained popularity thanks to its wristed instruments and magnified three-dimensional view, enhancing surgical comfort in remote-access areas. Its indications are expanding in the treatment of head and neck cancer, i.e., resection of tumors of the larynx, hypopharynx, or parapharyngeal space. However, this expansion must remain cautious and based on high-level evidence, in order to guarantee safety and oncological outcomes which are comparable to conventional approaches. This narrative review assesses the current role of TORS in head and neck cancer from an evidence-based perspective, and then identifies what knowledge gaps remain to be addressed.
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Affiliation(s)
- Mariam H. Mella
- Department of Otolaryngology, Head and Neck Surgery, Toulouse University Hospital—Larrey Hospital, 24 Chemin de Pouvourville, CEDEX 9, 31059 Toulouse, France
| | - Emilien Chabrillac
- Department of Surgery, University Cancer Institute of Toulouse—Oncopole, 31100 Toulouse, France
| | - Agnès Dupret-Bories
- Department of Otolaryngology, Head and Neck Surgery, Toulouse University Hospital—Larrey Hospital, 24 Chemin de Pouvourville, CEDEX 9, 31059 Toulouse, France
- Department of Surgery, University Cancer Institute of Toulouse—Oncopole, 31100 Toulouse, France
| | - Mathilde Mirallie
- Department of Otolaryngology, Head and Neck Surgery, Toulouse University Hospital—Larrey Hospital, 24 Chemin de Pouvourville, CEDEX 9, 31059 Toulouse, France
- Department of Surgery, University Cancer Institute of Toulouse—Oncopole, 31100 Toulouse, France
| | - Sébastien Vergez
- Department of Otolaryngology, Head and Neck Surgery, Toulouse University Hospital—Larrey Hospital, 24 Chemin de Pouvourville, CEDEX 9, 31059 Toulouse, France
- Department of Surgery, University Cancer Institute of Toulouse—Oncopole, 31100 Toulouse, France
- Correspondence: ; Tel.: +33-5-67-77-17-32
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Álvarez-Calderón-Iglesias O, Pérez-Sayáns M, Hurtado-Ruzza R, Lorenzo-Pouso A, Chamorro-Petronacci C. Survival outcomes in laryngeal chondrosarcoma: a systematic review. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2022; 42:502-515. [PMID: 36654516 PMCID: PMC9853110 DOI: 10.14639/0392-100x-n1912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 09/27/2022] [Indexed: 01/18/2023]
Abstract
Laryngeal chondrosarcomas (LCS) are rare lesions that behave as locally aggressive tumours, producing symptoms such as dysphonia, dyspnoea, dysphagia and hoarseness. Different approaches for the treatment of LCS have been described in the literature. The main purpose of this investigation was to find all cases of LCS published to date and analyse management data and survival outcomes. In December 2020, a systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Provider Enrollment, Chain, and Ownership System (PECOS) method including articles published up to this date on different aspects of LCS. The search included the terms larynx, laryngeal, chondrosarcoma. A total of 148 articles were included in this systematic review describing 381 cases of LCS. Dyspnoea was the most reported symptom followed by hoarseness and neck mass sensation. Cricoid cartilage was the most usual location. Survival rate was influenced by both surgical technique (log-rank = 11.7; p = 0.008) and the degree of tumour histologic differentiation (log-rank = 18.3; p = 0.003).
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Affiliation(s)
- Oscar Álvarez-Calderón-Iglesias
- Department of Health Sciences; Faculty of Nursing and Podiatry; Research, Health and Podiatry Group - Universidade da Coruña; HM Hospitals Research Foundation, Madrid, Spain
| | - Mario Pérez-Sayáns
- Oral Medicine, Oral Surgery and Implantology Unit, MedOralRes Group, Universidade de Santiago de Compostela, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain
| | - Rafael Hurtado-Ruzza
- Department of Otorhinolaryngology, Complexo Hospitalario Universitario de Ourense, Province of Ourense, Spain; Research, Health and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, Spain
| | - Alejandro Lorenzo-Pouso
- Oral Medicine, Oral Surgery and Implantology Unit, MedOralRes Group, Universidade de Santiago de Compostela, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain
| | - Cintia Chamorro-Petronacci
- Oral Medicine, Oral Surgery and Implantology Unit, MedOralRes Group, Universidade de Santiago de Compostela, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain,Correspondence Cintia Micaela Chamorro Petronacci C/ entrerrios S/N, CP: 15706, Santiago de Compostela, Spain Tel.: +34 651011815 E-mail:
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Hans S, Baudouin R, Circiu MP, Couineau F, Lisan Q, Crevier-Buchman L, Lechien JR. Laryngeal Cancer Surgery: History and Current Indications of Transoral Laser Microsurgery and Transoral Robotic Surgery. J Clin Med 2022; 11:jcm11195769. [PMID: 36233637 PMCID: PMC9571943 DOI: 10.3390/jcm11195769] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/23/2022] [Accepted: 09/24/2022] [Indexed: 11/21/2022] Open
Abstract
The development of transoral laser microsurgery (TLM) was an important step in the history of conservative laryngeal surgery. TLM reported comparable oncological outcomes and better functional postoperative and rehabilitation outcomes than open partial laryngectomy. TLM is currently considered as the standard surgical approach for early-stage laryngeal carcinoma. However, TLM has many limitations, including the limited view of the surgical field through the laryngoscope, exposure difficulties for some tumor locations, and a long learning curve. The development of transoral robotic surgery (TORS) appears to be an important issue to overcome these limitations. The current robotic technologies used in surgery benefited from the research of the U.S. Military and National Aeronautics and Space Administration (NASA) in the 1970s and 1980s. The first application in humans started in the 2000s with the first robotic-assisted cholecystectomy in the US, performed by a surgeon located in France. The use of robots in otolaryngology occurred after the development of the Da Vinci system in digestive surgery, urology, and gynecology, and mainly concerns cT1-T2 and some selected cT3 oropharyngeal and supraglottic carcinomas. With the development of a new robotic system with smaller arms and instruments, TORS indications will probably evolve in the next few years, leading to better outcomes for laryngeal or hypopharyngeal carcinomas.
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Affiliation(s)
- Stéphane Hans
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), 92150 Paris, France
| | - Robin Baudouin
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), 92150 Paris, France
| | - Marta P. Circiu
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), 92150 Paris, France
| | - Florent Couineau
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), 92150 Paris, France
| | - Quentin Lisan
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), 92150 Paris, France
| | - Lise Crevier-Buchman
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), 92150 Paris, France
| | - Jerome R. Lechien
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), 92150 Paris, France
- Division of Laryngology and Broncho-Esophagology, EpiCURA Hospital, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), 7000 Mons, Belgium
- Polyclinic of Poitiers—Elsan, 86000 Poitiers, France
- Correspondence:
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Simon C, Beharry A, Paleri V, Dübi P, Lambercy K, Holsinger FC, Todic J. The robotic-assisted extended "Sistrunk" approach for tumors of the upper aerodigestive tract with limited transoral access: First description of oncological and functional outcomes. Head Neck 2022; 44:2335-2341. [PMID: 35656594 PMCID: PMC9546007 DOI: 10.1002/hed.27114] [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: 12/03/2021] [Revised: 05/23/2022] [Accepted: 05/23/2022] [Indexed: 11/08/2022] Open
Abstract
We report on the first clinical experience with the robotic-assisted extended "Sistrunk" approach (RESA) for access to constrained spaces of the upper aerodigestive tract. This prospective case cohort study include six patients that underwent RESA if transoral exposure could not be achieved. Three patients received previous radiation. Patients were postoperatively followed until week 16 for perioperative complications, surgical margins, and functional outcomes. In all patients RESA allowed adequate exposure and resection with negative margins. Three patients who underwent salvage surgery experienced a minor or intermediate grade postoperative bleeding. No patient developed a pharyngocutaneous fistula. Three patients recovered their swallowing to their preoperative status and the remaining three experienced an improvement. All patients experienced complete recovery of their voice. RESA has the potential to provide a new organ preservation approach for head and neck cancer (HNC) not amenable to transoral exposure and thus warrants further prospective clinical studies.
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Affiliation(s)
- Christian Simon
- Department of Otolaryngology - Head and Neck Surgery, CHUV, University of Lausanne, Lausanne, Switzerland
| | - Avinash Beharry
- Department of Otolaryngology - Head and Neck Surgery, CHUV, University of Lausanne, Lausanne, Switzerland
| | - Vinidh Paleri
- Head and Neck Unit, The Royal Marsden Hospitals NHS Foundation Trust, London, UK
| | - Pascaline Dübi
- Department of Otolaryngology - Head and Neck Surgery, CHUV, University of Lausanne, Lausanne, Switzerland
| | - Karma Lambercy
- Department of Otolaryngology - Head and Neck Surgery, CHUV, University of Lausanne, Lausanne, Switzerland
| | | | - Jelena Todic
- Department of Otolaryngology - Head and Neck Surgery, CHUV, University of Lausanne, Lausanne, Switzerland
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Hans S, Chebib E, Chekkoury-Idrissi Y, Distinguin L, Circiu M, Vialatte de Pemille G, Julien-Laferriere A, Crevier-Buchman L, Lechien JR. Surgical and oncological outcomes of transoral robotic total laryngectomy: A case series. Oral Oncol 2021; 121:105511. [PMID: 34474271 DOI: 10.1016/j.oraloncology.2021.105511] [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: 08/15/2020] [Revised: 08/01/2021] [Accepted: 08/22/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate the oncological, functional and voice rehabilitation outcomes of transoral robotic surgery for total laryngectomy (TORS-TL). METHODS A retrospective chart review of patients treated by TORS-TL was conducted at a single academic medical center. The following outcomes were studied: indication; average robotic set-up and operative times; mean estimated blood loss; postoperative complications; re-feeding features; mean hospital stay; need of adjuvant therapy and voice rehabilitation type. RESULTS TORS-TL was performed in 10 patients for the following indications: nonfunctional larynx (N = 2); low-grade cricoid chondrosarcoma (N = 3) and recurrent laryngeal cancer after (chemo) radiation (N = 5). Two patients were excluded because the larynx was not exposable. Average robotic set-up and operative times were 20 and 278 min, respectively. The mean estimated blood loss was 50 mL. The mean hospital stay was 13.9 days (8-28 days). There was no local recurrence in patients operated for cancer recurrence (N = 5) 5 years after the surgery. Distant metastases occurred in one patient. A patient with laryngeal chondrosarcoma experienced local failure 3 years after TORS-TL. The voice rehabilitation consisted of esophageal voice (N = 2) and tracheoesophageal prosthesis (Provox®, N = 8). The main reasons for prosthesis replacement were transprosthetic (79%) and periprosthetic leaks (21%). The median lifespan of prostheses was 81 days. CONCLUSION TORS-TL may be a safe and effective surgical approach for selected surgical indications. Future controlled studies are needed to determine additional indications and limitations of this procedure.
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Affiliation(s)
- Stéphane Hans
- Robotic Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Emilien Chebib
- Robotic Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Younès Chekkoury-Idrissi
- Robotic Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Léa Distinguin
- Robotic Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Marta Circiu
- Robotic Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Grégoire Vialatte de Pemille
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Aude Julien-Laferriere
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Lise Crevier-Buchman
- Robotic Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Jérôme R Lechien
- Robotic Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium.
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Abstract
Technological developments have disrupted the practice of medicine throughout history. Endoscopic and robotic techniques in head and neck surgery have emerged over the past half-century and have been incrementally adapted to expanding indications within otolaryngology. Robotic and endoscopic surgery have an established role in treatment of oropharyngeal and laryngeal cancers, reducing surgical morbidity and improving survival relative to traditional open approaches. Surgical treatment of human papillomavirus-mediated oropharyngeal cancer via transoral robotic surgery offers equivalent oncologic and functional outcomes relative to radiotherapy. Newer iterations of single-port robotic systems continue to expand the scope of robotics in head and neck surgery.
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10
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Poma S, Modica DM, Pitruzzella A, Fucarino A, Mattina G, Fasola S, Pirrello D, Galfano GM. Robotic-Assisted Neck Dissection: Our Experience. Int Arch Otorhinolaryngol 2021; 26:e178-e182. [PMID: 35096176 PMCID: PMC8789484 DOI: 10.1055/s-0040-1718957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 08/23/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction
Robotic neck dissection surgery allows less invasiveness to significantly improve the aesthetic impact even though it does not compromise the principles of radical cancer procedure.
Objective
The aim of our work is to describe our personal experience with robotic neck dissection surgery.
Methods
A retrospective study was conducted by analyzing 10 patients subjected to a robotic neck dissection surgery. In the period from August 2012 to December 2018, these patients have been treated exclusively with robotic lateral-cervical dissection. Five of them were subjected to robotic-assisted transaxillary neck dissection (RATAND) and the other 5 treated with robotic-assisted retroauricular neck dissection (RARAND), then the surgical results have been compared with 5 similar dissections performed by open neck dissection (OND).
Results
The average surgical time of RATAND was estimated in 166 minutes, the average surgical time of RARAND was estimated in 153 minutes and the average surgical time of OND was estimated in 48 minutes. Both robotic techniques are valid from the oncological and aesthetic point of view, but in terms of surgical time, they are much longer than the open technique.
Conclusions
In terms of the post-operative decree, in our opinion, the retroauricular technique is more rapid for the purposes of recovery.
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Affiliation(s)
- Salvatore Poma
- U.O.C. Otolaryngology, Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | - Domenico Michele Modica
- U.O.C. Otolaryngology, Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
- U.O.C. Department of Biomedicine, Neuroscience and Advanced Diagnostics, Institute of Human Anatomy and Histology, University of Palermo, Palermo, Italy
| | - Alessandro Pitruzzella
- U.O.C. Department of Biomedicine, Neuroscience and Advanced Diagnostics, Institute of Human Anatomy and Histology, University of Palermo, Palermo, Italy
| | - Alberto Fucarino
- U.O.C. Department of Biomedicine, Neuroscience and Advanced Diagnostics, Institute of Human Anatomy and Histology, University of Palermo, Palermo, Italy
| | - Gianfranco Mattina
- U.O.C. Otolaryngology, Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
- U.O.C. Department of Biomedicine, Neuroscience and Advanced Diagnostics, Institute of Human Anatomy and Histology, University of Palermo, Palermo, Italy
| | - Salvatore Fasola
- Institute of Biomedicine and Molecular Immunology, “A. Monroy” (IBIM), CNR, Palermo, Italy
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11
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Hoffmann TK. Total Laryngectomy-Still Cutting-Edge? Cancers (Basel) 2021; 13:1405. [PMID: 33808695 PMCID: PMC8003522 DOI: 10.3390/cancers13061405] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/15/2021] [Accepted: 03/15/2021] [Indexed: 02/05/2023] Open
Abstract
Surgical removal of the larynx (total laryngectomy) offers a curative approach to patients with advanced laryngeal and hypopharyngeal (squamous cell) cancer without distant metastases. Particularly in T4a carcinoma, laryngectomy seems prognostically superior to primary radio(chemo)therapy. Further relevant indications for laryngectomy include massive laryngeal dysfunction associated with aspiration and recurrence after radio(chemo)therapy, resulting in salvage surgery. The surgical procedure including neck dissection is highly standardised and safe. The resulting aphonia can be compensated by functional rehabilitation (e.g., voice prosthesis) associated with a significant quality of life improvement. This article presents an overview of indications, preoperative diagnostics, surgical procedures, including new developments (robotics), possible complications, the choice of adjuvant treatment, alternative therapeutic approaches, rehabilitation and prognosis. In summary, total laryngectomy still represents a relevant surgical procedure in modern head and neck oncology.
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Affiliation(s)
- Thomas K Hoffmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Hospital, 89070 Ulm, Germany
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Chebib E, Lechien JR, Chekkoury-Idrissi Y, Circiu MP, Distinguin L, Pouliquen C, Hans S. Limitations of Transoral Robotic Total Laryngectomy. J Voice 2020; 35:681-682. [PMID: 33339704 DOI: 10.1016/j.jvoice.2020.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 11/30/2020] [Accepted: 12/02/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Emilien Chebib
- Robotic Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Jérôme R Lechien
- Robotic Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France.
| | - Younes Chekkoury-Idrissi
- Robotic Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Marta P Circiu
- Robotic Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Léa Distinguin
- Robotic Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Christelle Pouliquen
- Department of Pathology, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Stéphane Hans
- Robotic Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
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Wang CC, Lin WJ, De Virgilio A, Liu SA, Chen SH, Liao JS. Long-term outcomes of trans-oral robotic surgery-assisted total laryngectomy for recurrent laryngeal cancers. Jpn J Clin Oncol 2020; 50:653-660. [PMID: 32236415 DOI: 10.1093/jjco/hyaa034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 02/22/2020] [Accepted: 02/29/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE For recurrent laryngeal cancers, trans-oral robotic surgery has been used to perform total laryngectomy, but limited cases had been reported without long-term outcome follow-up. This study aims at presenting the largest longitudinal retrospective cohort in a single tertiary referral medical center. METHODS From November 2013 to August 2017, seven patients with recurrent laryngeal cancers without evidence of neck metastasis were selected to receive trans-oral robotic surgery-assisted TL without neck dissection. The para-operative details including the surgical success rates, surgical methods, resection extent, drainage tube placement, pharyngeal wound closure, console surgical time, pathologic findings and long-term complications were reviewed and described. The study end points include survival rates and preservation of swallowing function without tube feeding. RESULTS Trans-oral robotic surgery-assisted total laryngectomy was successfully performed on all seven patients with mean surgical console time of 111 ± 66 min. Strap muscles and hyoid bone were resected like open surgery in six and five patients, respectively. For all the seven patients, there was no severe pharyngo-cutaneous fistula formation requiring repair in a second surgery, but tracheostoma stenosis was not uncommon (57%). Three patients received adjuvant chemotherapy/radiotherapy. After follow-up of 36.1 ± 15.8 months, two patients had neck recurrence, and one patient died 19 months after surgery, but the other five patients were alive without disease recurrence. The overall survival rate was 85.7% (6/7), and all patients had good swallowing function without tube feeding. CONCLUSIONS Trans-oral robotic surgery-assisted total laryngectomy is a feasible approach for selected patients with recurrent laryngeal cancers. The oncologic and functional outcomes were satisfactory. Further larger cohort study is worthwhile to further elucidate the value of trans-oral robotic surgery-assisted total laryngectomy.
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Affiliation(s)
- Chen-Chi Wang
- School of Medicine, National Yang-Ming University, Taipei.,School of Speech Language Pathology and Audiology, Chung Shan Medical University, Taichung.,Department of Audiology and Speech-Language Pathology, Asia University, Taichung.,Department of Otolaryngology-Head and Neck Surgery, Taichung Veterans General Hospital, Taichung
| | - Wen-Jiun Lin
- Department of Otolaryngology-Head and Neck Surgery, Taichung Veterans General Hospital, Taichung
| | - Armando De Virgilio
- Otorhinolaryngology Unit, Humanitas University, Humanitas Clinical and Research Center-IRCCS, Rozzano, Italy
| | - Shih-An Liu
- School of Medicine, National Yang-Ming University, Taipei.,Department of Otolaryngology-Head and Neck Surgery, Taichung Veterans General Hospital, Taichung
| | - Sheng-Hwa Chen
- Department of Audiology and Speech-Language Pathology, Asia University, Taichung
| | - Jia-Shiou Liao
- School of Speech Language Pathology and Audiology, Chung Shan Medical University, Taichung.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
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Simon C, Holsinger FC, Rheinwald M, Kemper J, Lambercy K. A new endoscopic surgical approach to the larynx, hypopharynx, and neck lymphatics: The robotic-assisted extended "Sistrunk" approach (RESA). Head Neck 2020; 42:2750-2756. [PMID: 32533578 DOI: 10.1002/hed.26273] [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: 04/28/2020] [Accepted: 05/04/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We report on the feasibility of a novel robotic-assisted extended "Sistrunk" approach (RESA) to the larynx, hypopharynx, and lateral neck lymphatics. METHODS Studies were performed using the da Vinci Xi and SP system on three cadavers comprising of three supraglottic laryngectomies, one partial hypopharyngectomy, and four lateral level II to IV neck dissections. RESULTS In all resections at first a central common working space overlying the hyoid bone was created. The da Vinci Xi system was used with two vestibular and two submental ports for laryngeal/hypopharyngeal resections, and an additional port through a facelift incision for level II to IV neck dissections. The da Vinci SP system was used with only one submental port. CONCLUSIONS We describe herein a novel endoscopic robotic approach to the larynx, hypopharynx, and neck based on the traditional "Sistrunk" procedure. The technique should help improving exposure of the primary lesion and reduce access-related morbidity to the neck.
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Affiliation(s)
- Christian Simon
- Department of Otolaryngology - Head and Neck Surgery, CHUV, University of Lausanne, Lausanne, Switzerland
| | | | - Markus Rheinwald
- Department of Global Clinical Development, Intuitive Surgical, Sunnyvale, California, USA
| | - Justin Kemper
- Department of Global Clinical Development, Intuitive Surgical, Sunnyvale, California, USA
| | - Karma Lambercy
- Department of Otolaryngology - Head and Neck Surgery, CHUV, University of Lausanne, Lausanne, Switzerland
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Hardman J, Liu Z, Brady G, Roe J, Kerawala C, Riva F, Clarke P, Kim D, Bhide S, Nutting C, Harrington K, Paleri V. Transoral robotic surgery for recurrent cancers of the upper aerodigestive tract—Systematic review and meta‐analysis. Head Neck 2020; 42:1089-1104. [DOI: 10.1002/hed.26100] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 12/04/2019] [Accepted: 01/28/2020] [Indexed: 11/09/2022] Open
Affiliation(s)
- John Hardman
- Head and Neck Unit The Royal Marsden NHS Foundation Trust London UK
- Institute of Cancer Research London UK
| | - ZiWei Liu
- Head and Neck Unit The Royal Marsden NHS Foundation Trust London UK
| | - Grainne Brady
- Department of Speech and Language Therapy The Royal Marsden NHS Foundation Trust London UK
| | - Justin Roe
- Department of Speech and Language Therapy The Royal Marsden NHS Foundation Trust London UK
- Department of Surgery and Cancer Imperial College London UK
- Department of Otolaryngology Head and Neck Surgery, Imperial College Healthcare NHS Trust London UK
| | - Cyrus Kerawala
- Head and Neck Unit The Royal Marsden NHS Foundation Trust London UK
| | - Francesco Riva
- Head and Neck Unit The Royal Marsden NHS Foundation Trust London UK
| | - Peter Clarke
- Head and Neck Unit The Royal Marsden NHS Foundation Trust London UK
- Department of Otolaryngology Head and Neck Surgery, Imperial College Healthcare NHS Trust London UK
| | - Dae Kim
- Head and Neck Unit The Royal Marsden NHS Foundation Trust London UK
- Institute of Cancer Research London UK
| | - Shreerang Bhide
- Head and Neck Unit The Royal Marsden NHS Foundation Trust London UK
- Institute of Cancer Research London UK
| | - Christopher Nutting
- Head and Neck Unit The Royal Marsden NHS Foundation Trust London UK
- Institute of Cancer Research London UK
| | - Kevin Harrington
- Head and Neck Unit The Royal Marsden NHS Foundation Trust London UK
- Institute of Cancer Research London UK
| | - Vinidh Paleri
- Head and Neck Unit The Royal Marsden NHS Foundation Trust London UK
- Institute of Cancer Research London UK
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Abstract
Total laryngectomy provides a curative approach for patients with advanced laryngeal and hypopharyngeal cancer without distant metastasis. Especially in stage cT4a disease, laryngectomy is superior to primary radio(chemo)therapy in retrospective studies. Further relevant indications for the procedure are tumor-related laryngeal dysfunction such as dysphagia and aspiration, as well as cancer recurrence after primary radio(chemo)therapy. The surgical procedure is highly standardized, with an appropriate safety profile. The subsequent loss of voice must be compensated by voice rehabilitation (voice prosthesis, ructus). The current overview provides information about indications for laryngectomy, preoperative clinical diagnostics, the surgical procedure, complications, alternative treatment, rehabilitation, and prognosis. Total laryngectomy remains a standard procedure in modern head and neck oncology.
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Sukato DC, Ballard DP, Abramowitz JM, Rosenfeld RM, Mlot S. Robotic versus conventional neck dissection: A systematic review and meta-analysis. Laryngoscope 2018; 129:1587-1596. [DOI: 10.1002/lary.27533] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Indexed: 12/21/2022]
Affiliation(s)
- Daniel C. Sukato
- Department of Otolaryngology; SUNY Downstate Medical Center; Brooklyn New York U.S.A
| | - Daniel P. Ballard
- Department of Otolaryngology; SUNY Downstate Medical Center; Brooklyn New York U.S.A
| | - Jason M. Abramowitz
- Department of Otolaryngology; SUNY Downstate Medical Center; Brooklyn New York U.S.A
| | - Richard M. Rosenfeld
- Department of Otolaryngology; SUNY Downstate Medical Center; Brooklyn New York U.S.A
| | - Stefan Mlot
- Department of Otolaryngology; SUNY Downstate Medical Center; Brooklyn New York U.S.A
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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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Abstract
IMPORTANCE Transoral robotic surgery has revolutionized the practice of head and neck surgery over the past decade, with indications now expanding to include laryngeal pathology. Although laryngeal chondrosarcoma is a rare entity, trends in otolaryngology literature suggest that it can frequently be managed with conservative approaches. We hope to inspire other head and neck surgeons to consider transoral robotic surgery for the treatment of such tumors so that outcomes data can be collected and studied. OBSERVATION An 87-year-old male presented with a left-sided supraglottic mass that was found incidentally on imaging performed for an unrelated reason. Flexible fiberoptic laryngoscopy revealed a cystic-appearing supraglottic mass with near complete obstruction of the glottis airway. Internal review of the imaging demonstrated a 3.5 by 2.3 by 2.8 cm centrally hypodense lesion with a rim of calcification in the left paraglottic space, with resultant narrowing of the laryngeal airway. INTERVENTION The patient underwent awake tracheostomy and transoral robotic subtotal resection of the mass using the Da Vinci surgical system (Intuitive Surgical Inc., Sunnyvale, CA, USA). The vocal folds, ventricular mucosa, and arytenoid cartilage were grossly preserved. Final pathology revealed a low-grade cartilaginous neoplasm consistent with low-grade chondrosarcoma. CONCLUSIONS AND RELEVANCE Chondrosarcoma of the larynx is a rare entity that accounts for roughly 1% of laryngeal neoplasms. Recent trends in otolaryngology literature and practice suggest that low-grade chondrosarcomas can be effectively treated with organ-preserving, conservative surgery. Transoral robotic surgery offers numerous advantages over both open and endoscopic approaches. To our knowledge, this is the first report in the literature describing the successful use of transoral robotic surgery for the resection of a laryngeal chondrosarcoma.
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Gorphe P. A Contemporary Review of Evidence for Transoral Robotic Surgery in Laryngeal Cancer. Front Oncol 2018; 8:121. [PMID: 29721446 PMCID: PMC5915483 DOI: 10.3389/fonc.2018.00121] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 04/04/2018] [Indexed: 12/03/2022] Open
Abstract
Numerous studies have shown that transoral robotic surgery (TORS) for oropharyngeal cancers is safe and that it yields satisfactory functional and oncological outcomes. For many teams worldwide, it is therefore a standard surgical approach with eligible patients. In the same time, TORS is increasingly being used and described in the context of laryngeal cancer surgery. It is proposed as an alternative to open approaches, which may yield inconsistent functional results and significant rates of postoperative complications. It may also be an alternative to definitive radiotherapy, which entails significant early and late toxicities. Moreover, it has been explored as an alternative to endoscopic laser surgery in patients with difficult exposure, even though there is still a lack of evidence about which procedure provides better vizualization of the vocal cords. This article provides a review of the indications for TORS in laryngeal cancer, the peri-operative morbidity, functional outcomes, and oncological results.
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Affiliation(s)
- Philippe Gorphe
- Department of Head and Neck Oncology, Institute Gustave Roussy, Université Paris-Saclay, Villejuif, France
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Abstract
In the head and neck region, great potential is seen in robot-assisted surgery (RAS). Mainly in cancer surgery, the use of robotic systems seems to be of interest. Until today, two robotic systems (DaVinci® und FLEX®) have gained approval for clinical use in the head and neck region, and multiple other systems are currently in pre-clinical testing. Although, certain groups of patients may benefit from RAS, no unbiased randomized clinical studies are available. Until today, it was not possible to satisfactorily prove any advantage of RAS as compared to standard procedures. The limited clinical benefit and the additional financial burden seem to be the main reasons, why the comprehensive application of RAS has not been realized so far.This review article describes the large variety of clinical applications for RAS in the head and neck region. In addition, the financial and technical challenges, as well as ongoing developments of RAS are highlighted. Special focus is put on risks associated with RAS and current clinical studies. We believe, that RAS will find its way into clinical routine during the next years. Therefore, medical staff will have to increasingly face the technical, scientific and ethical features of RAS.
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Affiliation(s)
- Patrick J Schuler
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Ulm
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