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San Juan JD, Mendelsohn AH. Evaluation and application of CO 2 laser fiber delivery for single port transoral robotic surgery. Int J Med Robot 2023:e2510. [PMID: 36791776 DOI: 10.1002/rcs.2510] [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: 11/13/2022] [Revised: 02/01/2023] [Accepted: 02/13/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Transoral robotic surgery (TORS) using the Single-Port system (SPS) relies on electrocautery, limiting its applications in the upper aerodigestive tract. We evaluated the feasibility of a CO2 delivery system for the SPS. METHODS Otolaryngology residents performed a cutting exercise using a handheld CO2 laser and participated in a cadaveric oropharyngeal dissection using the SPS with monopolar cautery (SP + EC) and CO2 laser (SP + CO2 ). Residents completed the System Usability Scale (SUS) questionnaire to evaluate these techniques. RESULTS The same laser fiber was used for all combined dissections. The handheld CO2 laser, SP + EC, and SP + CO2 demonstrated similar SUS scores. On individual domain scores, SP + CO2 received less favorable ratings compared to the handheld CO2 laser for complexity, integration, and cumbersome experience (p < 0.05). On subgroup stratification, less TORS experience was associated with worse SUS scores. CONCLUSION SP-guided CO2 laser delivery is a viable alternative to electrocautery in robotic surgery, and should be considered when performing TORS.
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Affiliation(s)
- Juan D San Juan
- UCLA David Geffen School of Medicine Department of Head and Neck Surgery, Los Angeles, California, USA
| | - Abie H Mendelsohn
- UCLA David Geffen School of Medicine Department of Head and Neck Surgery, Los Angeles, California, USA
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2
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Canzi P, Maiorano E, Sovardi F, Nardo M, Occhini A, Benazzo M. A Rare Presentation of Recalcitrant Oropharyngeal Stenosis in a 54-Year-Old Male Patient Following Transoral Robotic Surgery for Obstructive Sleep Apnea. AMERICAN JOURNAL OF CASE REPORTS 2022; 23:e937123. [PMID: 36423243 PMCID: PMC9706484 DOI: 10.12659/ajcr.937123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 11/04/2022] [Accepted: 09/07/2022] [Indexed: 07/24/2024]
Abstract
BACKGROUND Transoral robotic surgery (TORS) is an effective and safe option for obstructive sleep apnea syndrome (OSAS) patients with isolated retrolingual obstruction, as well as part of multilevel surgical approach in case of multilevel obstruction. Stenosis after TORS in OSAS patients is rarely described and no literature review has investigated this dramatic untoward event. CASE REPORT We report on a case of severe recalcitrant oropharyngeal stenosis after multilevel surgery with transoral robotic tongue base resection in an OSAS patient, leading to tracheotomy and gastrostomy dependence. Following the failure of numerous conservative therapeutic attempts, oropharyngeal patency was restored after extensive scar tissue removal through an open-neck approach, followed by a pharyngeal reconstruction with radial forearm free flap (RFFF). CONCLUSIONS Recalcitrant oropharyngeal stenosis is a dramatic complication that must be considered in OSAS patients submitted to TORS in a multilevel strategy and that is rarely described in the literature. A thorough review of the existing literature is presented to assess which factors are involved and the therapeutic strategies invoked in this scenario. The adoption of resection tools suited for robot-assisted surgery and the staging of TORS in case of multilevel surgery could decrease the risk of extensive scar formation. To date there is still no broad consensus on which therapeutic choice is the best for recalcitrant oropharyngeal stenosis. When minimally invasive treatments fail, a wide scar resection with a RFFF oropharyngeal reconstruction could be considered as a valuable option to restore the upper aerodigestive tract patency.
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Affiliation(s)
- Pietro Canzi
- Department of Otorhinolaryngology, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
- University of Pavia, Pavia, Italy
| | - Eugenia Maiorano
- Department of Otorhinolaryngology, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Fabio Sovardi
- Department of Otorhinolaryngology, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Matteo Nardo
- Department of Otorhinolaryngology, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
- University of Pavia, Pavia, Italy
| | - Antonio Occhini
- Department of Otorhinolaryngology, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Marco Benazzo
- Department of Otorhinolaryngology, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
- University of Pavia, Pavia, Italy
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Meulemans J, Vandebroek T, Ourak M, Vander Poorten E, Vander Poorten V. Preclinical implementation of a steerable, Da Vinci Xi® compatible CO 2 -laser fibre carrier for transoral robotic surgery (TORS): A cadaveric feasibility study. Int J Med Robot 2021; 18:e2342. [PMID: 34652069 DOI: 10.1002/rcs.2342] [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: 06/07/2021] [Revised: 10/02/2021] [Accepted: 10/12/2021] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Monopolar electrocautery is the most common dissection and coagulation tool during transoral robotic surgery (TORS) but causes significant collateral tissue damage as opposed to CO2 laser. We aimed at combining both modalities in one robotic instrument arm. METHODS We developed a steerable CO2 -laser fibre carrier serving as an add-on to the existing Endowrist® monopolar spatula of the Da Vinci Xi. Feasibility and safety were assessed in a preclinical setting. RESULTS One radical tonsillectomy with monopolar cautery and three with the instrument prototype were performed in two cadavers by two surgeons. No serious prototype-related intra-operative difficulties were observed. Safe and efficient switching between energy sources proved possible in all simulated intra-operative bleeding events. Prototype use allowed for the identification of the majority of key anatomical structures and was scored favourably on NASA-TLX questionnaires. DISCUSSION The reported prototype successfully combines the advantages of CO2 -laser with the advantages of TORS.
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Affiliation(s)
- Jeroen Meulemans
- Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| | - Tom Vandebroek
- Department of Mechanical Engineering, KU Leuven, Leuven, Belgium
| | - Mouloud Ourak
- Department of Mechanical Engineering, KU Leuven, Leuven, Belgium
| | | | - Vincent Vander Poorten
- Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
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Benyo S, Keane A, Warrick J, Choi KY. HPV-positive oral papillomas in an adolescent-A diagnostic dilemma. Clin Case Rep 2021; 9:e04546. [PMID: 34401152 PMCID: PMC8347631 DOI: 10.1002/ccr3.4546] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/09/2021] [Accepted: 06/16/2021] [Indexed: 12/31/2022] Open
Abstract
Human papillomavirus oral papilloma is often sexually transmitted, but non-sexual modes of transmission should be considered, including autoinoculation from skin lesions. A patient-centered multimodality approach should be utilized in the pediatric population.
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Affiliation(s)
- Sarah Benyo
- The Pennsylvania State UniversityCollege of MedicineHersheyPAUSA
| | - Allison Keane
- Department of Otolaryngology – Head and Neck SurgeryThe Pennsylvania State UniversityCollege of MedicineHersheyPAUSA
| | - Joshua Warrick
- Department of Pathology and Laboratory Medicine, The Pennsylvania State UniversityCollege of MedicineHersheyPAUSA
| | - Karen Y. Choi
- Department of Otolaryngology – Head and Neck SurgeryThe Pennsylvania State UniversityCollege of MedicineHersheyPAUSA
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Hofauer B, Mansour N, Becker C, Ketterer MC, Knopf A. [Functional outcomes after surgical treatment of oropharyngeal carcinomas]. HNO 2021; 69:95-100. [PMID: 32430667 DOI: 10.1007/s00106-020-00887-0] [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: 10/24/2022]
Abstract
INTRODUCTION The primary goal of surgical resection of oropharyngeal carcinoma (OPSCC) is an R0 resection. The extension of the primary tumor is decisive for selection of access route, which should be as circumscribed as possible but as radical as necessary. To date, there are no prospective comparative studies that compared functional outcome in terms of surgical access route. MATERIALS AND METHODS A selective literature search was carried out for the period from 01/01/2000 to 12/31/2019 to assess the functional result after different surgical approaches in the treatment of OPSCC. The search strategy aimed to identify publications that investigated the functional result of transoral approaches, robot-assisted transoral resections (TORS), and surgical resection using pharyngotomies or transmandibular approaches. RESULTS Various measures were identified which enable subjective and objective assessment of swallowing and speaking restrictions. For all surgical access routes, studies were identified that examined the functional aspects of the respective access, but there are no direct comparisons between the individual approaches. CONCLUSION There are various surgical approaches available for resection of OPSCC, each of which has been examined in various studies with regard to its oncological and functional results.
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Affiliation(s)
- B Hofauer
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinik Freiburg, Killianstraße 5, 79106, Freiburg, Deutschland.
| | - N Mansour
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinik Freiburg, Killianstraße 5, 79106, Freiburg, Deutschland
| | - C Becker
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinik Freiburg, Killianstraße 5, 79106, Freiburg, Deutschland
| | - M C Ketterer
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinik Freiburg, Killianstraße 5, 79106, Freiburg, Deutschland
| | - A Knopf
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinik Freiburg, Killianstraße 5, 79106, Freiburg, Deutschland
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Ross T, Tolley NS, Awad Z. Novel Energy Devices in Head and Neck Robotic Surgery - A Narrative Review. ROBOTIC SURGERY : RESEARCH AND REVIEWS 2020; 7:25-39. [PMID: 32426397 PMCID: PMC7187864 DOI: 10.2147/rsrr.s247455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 04/06/2020] [Indexed: 01/06/2023]
Abstract
The advent of trans-oral robotic surgery (TORS) has facilitated removal of tumors previously deemed unresectable, by providing access to the deep structures of the head and neck. Despite this, the wider dissemination of TORS has been restricted due to issues with line of access, as the da Vinci robot was never designed with head and neck surgery in mind. Flexible instruments and novel energy delivery devices offer great potential in overcoming some of the existing challenges surrounding TORS. This review aimed to summarize the existing literature surrounding energy delivery in TORS and highlight areas of future innovation. MEDLINE was searched for studies relating to energy delivery in TORS in November 2019. The existing literature surrounding monopolar and bipolar electrocautery, LASER (CO2, Tm:YAG and blue LASER), Ligasure and Harmonic was reviewed. Additionally, the latest iteration of the da Vinci; the SP, and the FLEX robot were evaluated as novel methods of energy delivery in TORS. Overall, these novel energy devices and robotic systems are predicted to further improve energy delivery to the head and neck. The use of flexible LASER in particular is well substantiated in the literature. This has the potential to achieve treatment de-escalation, based on the excellent outcomes demonstrated for disease-free margins and post-operative morbidity.
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Affiliation(s)
- Talisa Ross
- Department of Ear, Nose and Throat Surgery, London North West University Healthcare NHS Trust, London, UK.,Faculty of Medicine, Imperial College London, London, UK
| | - Neil S Tolley
- Faculty of Medicine, Imperial College London, London, UK.,Department of Ear, Nose and Throat Surgery, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Zaid Awad
- Faculty of Medicine, Imperial College London, London, UK.,Department of Ear, Nose and Throat Surgery, Imperial College Healthcare NHS Foundation Trust, London, UK
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