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Lee JJ, Rapoport NA, Pipkorn P, Puram SV, Jackson RS. Airway protection and outcomes after staged versus concurrent bilateral neck dissections with transoral base of tongue cancer resection. Head Neck 2024; 46:1020-1027. [PMID: 38414192 DOI: 10.1002/hed.27696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 12/30/2023] [Accepted: 02/08/2024] [Indexed: 02/29/2024] Open
Abstract
OBJECTIVES To assess airway, safety, and resource utilization outcomes between transoral base of tongue (BOT) surgery with staged versus concurrent bilateral neck dissections (BND). METHODS A retrospective cohort study of patients with human papilloma virus (HPV)-related BOT cancer who underwent transoral surgery and BND from January 2015 through June 2022 was conducted. Free flap patients were excluded. RESULTS Of 126 patients (46 [37%] staged and 80 [63%] concurrent BND), there were no significant differences in rates of postoperative intubation, tracheostomy, intensive care admission, operative takebacks, gastrostomy, and 30-day readmission. Total operative time (median difference 1.4 [95% CI 0.9-1.8] hours), length of stay (1.0 [1.0-1.0] day), and time between primary surgery and adjuvant therapy initiation (4.0 [0.0-8.0] days) were lower in the concurrent BND cohort. CONCLUSION Concurrent BND alongside transoral BOT resection is safe with similar airway outcomes and lower total operative time, length of stay, and time to adjuvant therapy initiation compared to staged BND.
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Affiliation(s)
- Jake J Lee
- Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | | | - Patrik Pipkorn
- Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Sidharth V Puram
- Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Genetics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ryan S Jackson
- Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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Mao S, Tang R, Gu Y, Chen B, Zhang W. Endoscopic endonasal combined transoral medial approach to the nasopharynx, parapharyngeal space, and jugular foramen. Head Neck 2024; 46:485-491. [PMID: 38095125 DOI: 10.1002/hed.27596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/11/2023] [Accepted: 11/30/2023] [Indexed: 02/13/2024] Open
Abstract
OBJECTIVE This study aimed to validate the feasibility of an endoscopic endonasal combined transoral medial approach for treating lesions in the nasopharynx, parapharyngeal space (PPS), and jugular foramen. METHODS Anatomical and imaging information of six patients who underwent surgery via this approach were reviewed and analyzed. RESULTS The feasibility and advantages of the endoscopic endonasal combined transoral medial approach, which uses an inside-to-outside medial surgical corridor, were identified. Total resection was achieved in 3 cases with benign tumors. Safe resection margins were obtained in 2 cases with recurrent nasopharyngeal carcinoma (NPC). Pathological biopsy of NPC lesion between the Eustachian tube and arterial sheath was achieved. The internal carotid artery (ICA) was accurately located and protected in all cases and no complications occurred. CONCLUSION Lesions in the nasopharynx, PPS, and jugular foramen can be directly assessed via this approach. The ICA can be well identified during the surgery.
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Affiliation(s)
- Song Mao
- Department of Otolaryngology Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ru Tang
- Department of Otolaryngology Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuelong Gu
- Department of Otolaryngology Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bin Chen
- Department of Otolaryngology Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weitian Zhang
- Department of Otolaryngology Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Maniaci A, Chiesa Estomba C, Fakhry N, Vaira LA, Remacle M, Cammaroto G, Barillari MR, Iannella G, Mayo-Yanez M, Saibene AM, Baudouin R, Maza-Solano J, Mendelsohn AH, Holsinger FC, Ceccon FP, Haddad L, Hans S, La Mantia I, Cocuzza S, Gulinello F, Ayad T, Lechien JR. Influence of Otolaryngological Subspecialties on Perception of Transoral Robotic Surgery: An International YO-IFOS Survey. J Pers Med 2023; 13:1717. [PMID: 38138944 PMCID: PMC10744671 DOI: 10.3390/jpm13121717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/04/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND To investigate perception, adoption, and awareness on the part of otolaryngology and head and neck surgeons (OTO-HNS) of transoral robotic surgery (TORS). METHODS Several items assessed: awareness/perception; access to TORS; training; indications and advantages/hurdles to TORS practice. A subanalysis was performed to assess differences according to the identified otolaryngological subspecialties. RESULTS A total of 359 people completed the survey. Among subspecialties, while for otolaryngologists 30/359 (8.4%) and H&N surgeons 100/359 (27.9%) TORS plays an effective role in hospital stay, laryngologists frequently disagreed (54.3%). There was a lower incidence among rhinologists and otologists (1.9%). Pediatric surgeons (0.8%) reported a positive response regarding the adoption of robotic surgery, and head and neck specialists expressed an even greater response (14.2%). Low adherence was related to perceived cost-prohibitive TORS, by 50% of H&N surgeons. CONCLUSIONS Perception, adoption, and knowledge about TORS play a key role in the application of the robotic system, significantly varying across subspecialties.
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Affiliation(s)
- Antonino Maniaci
- Robotics Study Group of Young Otolaryngologists, International Federation of Oto-Rhino-Laryngological Societies, 75000 Paris, France; (C.C.E.); (N.F.); (L.A.V.); (G.C.); (M.R.B.); (G.I.); (M.M.-Y.); (A.M.S.); (R.B.); (J.M.-S.); (T.A.); (J.R.L.)
- Faculty of Medicine and Surgery, University of Enna “Kore”, 94100 Enna, Italy
- Department of Oto-Rhino-Laryngology Head and Neck Surgery, La Conception University Hospital, AP-HM, Aix Marseille Univ, 13005 Marseille, France
| | - Carlos Chiesa Estomba
- Robotics Study Group of Young Otolaryngologists, International Federation of Oto-Rhino-Laryngological Societies, 75000 Paris, France; (C.C.E.); (N.F.); (L.A.V.); (G.C.); (M.R.B.); (G.I.); (M.M.-Y.); (A.M.S.); (R.B.); (J.M.-S.); (T.A.); (J.R.L.)
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Universitario Donostia, 20003 San Sebastian, Spain
| | - Nicolas Fakhry
- Robotics Study Group of Young Otolaryngologists, International Federation of Oto-Rhino-Laryngological Societies, 75000 Paris, France; (C.C.E.); (N.F.); (L.A.V.); (G.C.); (M.R.B.); (G.I.); (M.M.-Y.); (A.M.S.); (R.B.); (J.M.-S.); (T.A.); (J.R.L.)
- Department of Oto-Rhino-Laryngology Head and Neck Surgery, La Conception University Hospital, AP-HM, Aix Marseille Univ, 13005 Marseille, France
| | - Luigi Angelo Vaira
- Robotics Study Group of Young Otolaryngologists, International Federation of Oto-Rhino-Laryngological Societies, 75000 Paris, France; (C.C.E.); (N.F.); (L.A.V.); (G.C.); (M.R.B.); (G.I.); (M.M.-Y.); (A.M.S.); (R.B.); (J.M.-S.); (T.A.); (J.R.L.)
- Maxillofacial Surgery Unit, University Hospital of Sassari, 07025 Sassari, Italy
| | - Marc Remacle
- Department of Otorhinolaryngology-Head and Neck Surgery, CHL-Eich, Rue d’Eich 78, 1111 Luxembourg, Luxembourg;
| | - Giovanni Cammaroto
- Robotics Study Group of Young Otolaryngologists, International Federation of Oto-Rhino-Laryngological Societies, 75000 Paris, France; (C.C.E.); (N.F.); (L.A.V.); (G.C.); (M.R.B.); (G.I.); (M.M.-Y.); (A.M.S.); (R.B.); (J.M.-S.); (T.A.); (J.R.L.)
- Head-Neck, and Oral Surgery Unit, Department of Head-Neck Surgery, Otolaryngology, Morgagni Pierantoni Hospital, 47121 Forlì, Italy
| | - Maria Rosaria Barillari
- Robotics Study Group of Young Otolaryngologists, International Federation of Oto-Rhino-Laryngological Societies, 75000 Paris, France; (C.C.E.); (N.F.); (L.A.V.); (G.C.); (M.R.B.); (G.I.); (M.M.-Y.); (A.M.S.); (R.B.); (J.M.-S.); (T.A.); (J.R.L.)
- Department of Mental and Physical Health and Preventive Medicine, “L. Vanvitelli” University, 80121 Naples, Italy
| | - Giannicola Iannella
- Robotics Study Group of Young Otolaryngologists, International Federation of Oto-Rhino-Laryngological Societies, 75000 Paris, France; (C.C.E.); (N.F.); (L.A.V.); (G.C.); (M.R.B.); (G.I.); (M.M.-Y.); (A.M.S.); (R.B.); (J.M.-S.); (T.A.); (J.R.L.)
- Organi di Senso Department, Sapienza University of Rome, Viale del Policlinico 151, 00161 Rome, Italy
| | - Miguel Mayo-Yanez
- Robotics Study Group of Young Otolaryngologists, International Federation of Oto-Rhino-Laryngological Societies, 75000 Paris, France; (C.C.E.); (N.F.); (L.A.V.); (G.C.); (M.R.B.); (G.I.); (M.M.-Y.); (A.M.S.); (R.B.); (J.M.-S.); (T.A.); (J.R.L.)
- Otorhinolaryngology-Head and Neck Surgery Department, Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, 15001 Galicia, Spain
| | - Alberto Maria Saibene
- Robotics Study Group of Young Otolaryngologists, International Federation of Oto-Rhino-Laryngological Societies, 75000 Paris, France; (C.C.E.); (N.F.); (L.A.V.); (G.C.); (M.R.B.); (G.I.); (M.M.-Y.); (A.M.S.); (R.B.); (J.M.-S.); (T.A.); (J.R.L.)
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, 20121 Milan, Italy
| | - Robin Baudouin
- Robotics Study Group of Young Otolaryngologists, International Federation of Oto-Rhino-Laryngological Societies, 75000 Paris, France; (C.C.E.); (N.F.); (L.A.V.); (G.C.); (M.R.B.); (G.I.); (M.M.-Y.); (A.M.S.); (R.B.); (J.M.-S.); (T.A.); (J.R.L.)
- Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), 75000 Paris, France;
| | - Juan Maza-Solano
- Robotics Study Group of Young Otolaryngologists, International Federation of Oto-Rhino-Laryngological Societies, 75000 Paris, France; (C.C.E.); (N.F.); (L.A.V.); (G.C.); (M.R.B.); (G.I.); (M.M.-Y.); (A.M.S.); (R.B.); (J.M.-S.); (T.A.); (J.R.L.)
- Service of Otolaryngology, ENT Deparment, Virgen de la Macarena University Hospital,41000 Seville, Spain
| | - Abie H. Mendelsohn
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 94305, USA;
| | - Floyd Christopher Holsinger
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA;
| | - Fabio P. Ceccon
- Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Universidade Federal de São Paulo (UNIFESP), 06000 São Paulo, Brazil; (F.P.C.); (L.H.)
| | - Leonardo Haddad
- Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Universidade Federal de São Paulo (UNIFESP), 06000 São Paulo, Brazil; (F.P.C.); (L.H.)
| | - Stephane Hans
- Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), 75000 Paris, France;
| | - Ignazio La Mantia
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia” ENT Section, University of Catania, 95123 Catania, Italy; (I.L.M.); (S.C.); (F.G.)
| | - Salvatore Cocuzza
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia” ENT Section, University of Catania, 95123 Catania, Italy; (I.L.M.); (S.C.); (F.G.)
| | - Federica Gulinello
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia” ENT Section, University of Catania, 95123 Catania, Italy; (I.L.M.); (S.C.); (F.G.)
| | - Tareck Ayad
- Robotics Study Group of Young Otolaryngologists, International Federation of Oto-Rhino-Laryngological Societies, 75000 Paris, France; (C.C.E.); (N.F.); (L.A.V.); (G.C.); (M.R.B.); (G.I.); (M.M.-Y.); (A.M.S.); (R.B.); (J.M.-S.); (T.A.); (J.R.L.)
- Division of Otolaryngology-Head and Neck Surgery, Center Hospitalier de l’Université de Montréal, Head and Neck Deparment, Montreal, QC 54550, Canada
| | - Jerome R. Lechien
- Robotics Study Group of Young Otolaryngologists, International Federation of Oto-Rhino-Laryngological Societies, 75000 Paris, France; (C.C.E.); (N.F.); (L.A.V.); (G.C.); (M.R.B.); (G.I.); (M.M.-Y.); (A.M.S.); (R.B.); (J.M.-S.); (T.A.); (J.R.L.)
- Department of Otolaryngology and Head and Neck Surgery, Foch Hospital, Paris Saclay University, 75000 Paris, France
- Department of Otolaryngology and Head and Neck Surgery, Division of Broncho-Esophagology, EpiCURA Hospital, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), 7031 Mons, Belgium
- Department of Otolaryngology and Head and Neck Surgery, Elsan Polyclinic of Poitiers, 86000 Poitiers, France
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Li L, Li P, London NR, Xu H, Chen X, Carrau RL. Relevance of the Internal Jugular Vein for Surgery in the Upper Parapharyngeal Space. Ear Nose Throat J 2023:1455613231197730. [PMID: 37786236 DOI: 10.1177/01455613231197730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023] Open
Abstract
Objective: Tumors arising from the upper parapharyngeal space (UPPS) may have intimate relationships with the internal carotid artery (ICA) and the internal jugular vein (IJV). The significance of the ICA in UPPS has been sufficiently articulated, whereas the relevance of the IJV has not been addressed. This study aimed to assess the anatomical variations of the IJV within the UPPS, and to explore its implications for surgical procedures. Methods: An endoscopic dissection of the IJV was performed on 10 cadaveric specimens. In addition, 30 patients who underwent transoral or transcervical resection of UPPS tumors were retrospectively reviewed to characterize the IJV and its relation to the tumor. Results: On the cadaveric specimens, the IJV was located at the posteromedial and posterolateral aspects of the styloid process in 13 (65%) and 7 (35%) sides, respectively. In our clinical series, the IJV was not encountered in 18 patients with pre-styloid tumors. In 12 patients harboring retro-styloid tumors, the IJV was partially (n = 5) or completely (n = 7) compressed and was displaced into the posterolateral aspect of the tumor. The IJV was injured intraoperatively in 1 patient, requiring an immediate conversion to an open transcervical corridor that allowed its exposure and ligation without difficulty. Conclusion: This study characterizes the IJV and its relationship with adjacent neurovascular structures in the UPPS, which may provide further safeguards during transoral and transcervical procedures in the UPPS.
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Affiliation(s)
- Lifeng Li
- Department of Otolaryngology-Head & Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Department of Otolaryngology-Head & Neck Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University, Columbus, OH, USA
| | - Pingdong Li
- Department of Otolaryngology-Head & Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Nyall R London
- Department of Otolaryngology-Head & Neck Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University, Columbus, OH, USA
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Hongbo Xu
- Department of Otolaryngology-Head & Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xiaohong Chen
- Department of Otolaryngology-Head & Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ricardo L Carrau
- Department of Otolaryngology-Head & Neck Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University, Columbus, OH, USA
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Chen Y, Zhang G, Xu J, Zhang S, Zou J, Wu Y, Jiang Y, Xu Y. Initial Clinical Application of Enhanced Recovery After Transoral Robotic Thyroidectomy. J Laparoendosc Adv Surg Tech A 2023; 33:763-767. [PMID: 37366863 DOI: 10.1089/lap.2023.0099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
Abstract
Background: The enhanced recovery after surgery (ERAS) protocol has been widely adopted across various surgical subspecialties. Transoral robotic thyroidectomy (TORT) has grown in popularity in the past decade. Therefore, this study aimed to discuss the initial application of ERAS in TORT. Methods: We retrospectively analyzed the clinical data of 95 patients who had undergone TORT in our department from April 2020 to March 2022. All patients were treated using the ERAS protocol. Results: TORT was successfully performed in all 95 patients. Postoperative histopathological examination revealed papillary carcinoma. The average operative time, hemorrhage volume, length of postoperative stay, and pain score (24 hours after surgery) were 227.32 ± 44.37 minutes, 35.81 ± 23.45 mL, 1.37 ± 0.62 days, and 2.11 ± 0.54, respectively. Sixty patients received an analgesia pump, with no significant difference in pain scores between the patients with and without the pump (P > .05). Eight patients experienced transient mandibular numbness, and two experienced transient hoarseness postoperatively. Of the 24 cases of total thyroidectomy/bilateral subtotal thyroidectomy (ST) or lobectomy with isthmusectomy plus contralateral ST patients, 8 developed transient hypoparathyroidism. No common complications, such as incision infection, hematoma/effusion formation, coughing while drinking, or permanent hoarseness/hypocalcemia, were reported. Conclusion: Our initial outcomes demonstrate that implementing an ERAS protocol in TORT is safe and feasible.
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Affiliation(s)
- Yi Chen
- Department of Breast and Thyroid Surgery, Daping Hospital, Army Medical University, Chongqing, P.R. China
| | - Gang Zhang
- Department of Breast and Thyroid Surgery, Daping Hospital, Army Medical University, Chongqing, P.R. China
| | - Jing Xu
- Department of Breast and Thyroid Surgery, Daping Hospital, Army Medical University, Chongqing, P.R. China
| | - Shu Zhang
- Department of Breast and Thyroid Surgery, Daping Hospital, Army Medical University, Chongqing, P.R. China
| | - Jiaqun Zou
- Department of Breast and Thyroid Surgery, Daping Hospital, Army Medical University, Chongqing, P.R. China
| | - Yan Wu
- Department of Breast and Thyroid Surgery, Daping Hospital, Army Medical University, Chongqing, P.R. China
| | - Yan Jiang
- Department of Breast and Thyroid Surgery, Daping Hospital, Army Medical University, Chongqing, P.R. China
| | - Yan Xu
- Department of Breast and Thyroid Surgery, Daping Hospital, Army Medical University, Chongqing, P.R. China
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Wang Y, Wu G, Yan W, Lin F, Lin S, Luo Y, Zheng Y. Transoral endoscopic thyroid surgery via vestibular approach with silastic chin augmentation genioplasty. Exp Ther Med 2023; 26:357. [PMID: 37324516 PMCID: PMC10265711 DOI: 10.3892/etm.2023.12056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 04/03/2023] [Indexed: 06/17/2023] Open
Abstract
From July 2020 to March 2022, 3 patients with papillary thyroid cancer (PTC) and microgenia underwent transoral endoscopic thyroid surgery via a vestibular approach or a endoscopic lateral neck dissection via the breast and transoral approaches with chin silastic augmentation genioplasty performed concurrently. Image documentation, patient satisfaction, complications and other factors such as demographics and clinicopathologic details were recorded. None of the patients developed major complications and there were no complications such as infection or displacement of the implant. All patients were satisfied with the cosmetic outcomes. Despite the study being limited to these 3 selected patients with PTC and microgenia, the follow-up to our initial description of the new technique established its safety and efficacy.
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Affiliation(s)
- Yuanyuan Wang
- Department of Thyroid Surgery, Zhengzhou University First Affiliated Hospital of Zhengzhou, Zhengzhou, Henan 450000, P.R. China
| | - Guoyang Wu
- Department of General Surgery, Zhongshan Hospital, Xiamen University, Xiamen, Fujian 361004, P.R. China
| | - Wei Yan
- Department of General Surgery, Zhongshan Hospital, Xiamen University, Xiamen, Fujian 361004, P.R. China
| | - Fusheng Lin
- Department of General Surgery, Zhongshan Hospital, Xiamen University, Xiamen, Fujian 361004, P.R. China
| | - Suqiong Lin
- Department of General Surgery, Zhongshan Hospital, Xiamen University, Xiamen, Fujian 361004, P.R. China
| | - Yezhe Luo
- Department of General Surgery, Zhongshan Hospital, Xiamen University, Xiamen, Fujian 361004, P.R. China
| | - Yarong Zheng
- Department of Plastic Surgery, Zhongshan Hospital, Xiamen University, Xiamen, Fujian 361004, P.R. China
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Jiang J, He G, Chu J, Li J, Lu X, Jiang X, Xie L, Gao L, Zhang D. Gasless submental- transoral combined approach endoscopic thyroidectomy: a new surgical technique. Front Oncol 2023; 13:1115927. [PMID: 37324008 PMCID: PMC10264817 DOI: 10.3389/fonc.2023.1115927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 04/20/2023] [Indexed: 06/17/2023] Open
Abstract
Background The development of transoral endoscopic vestibular approach thyroidectomy (TOETVA) has been limited by inherent defects, such as mental nerve injury and carbon dioxide (CO2)-related complications. Herein, we proposed a new technique without CO2 called gasless submental-transoral combined approach endoscopic thyroidectomy (STET) to solve the problems in TOETVA. Methods We reviewed 75 patients who successfully underwent gasless STET using novel instruments at our institution from November 2020 to November 2021. A main incision of approximately 2 cm was made in the natural submental crease line and then combined with two vestibule incisions to complete the procedure. Demographic data, surgical technique and perioperative outcomes were retrospectively recorded. Results Thirteen male and sixty-two female patients with a mean age of 34.0 ± 8.1 years were enrolled in this study. Sixty-eight patients had papillary thyroid carcinomas and seven had benign nodules. We successfully performed all gasless STET without conversion to open surgery. The average postoperative hospital stay was 4.2 ± 1.8 days. One transient recurrent laryngeal nerve injury and two transient hypoparathyroidisms were observed. Three patients complained of slight lower lip numbness on the first postoperative day. One case of lymphatic fistula, subcutaneous effusion, and incision swelling occurred each, all of which were conservatively cured. One patient developed a recurrence six months after surgery. Conclusions Gasless STET using our own designed suspension system is technically safe and feasible with reasonable operative and oncologic results.
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Cheong I, Feijoo J, Tamagnone FM. Cerebral circulatory arrest diagnosed with transoral Doppler ultrasonography. J Clin Ultrasound 2023; 51:742-744. [PMID: 36426722 DOI: 10.1002/jcu.23404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/16/2022] [Accepted: 11/19/2022] [Indexed: 05/03/2023]
Abstract
We describe the case of a patient with malignant stroke in whom brain death was diagnosed by evaluating the neck vessels by transoral ultrasonography.
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Affiliation(s)
- Issac Cheong
- Department of critical care medicine, Sanatorio De los Arcos, Buenos Aires, Argentina
- Argentinian Critical Care Ultrasonography Association (ASARUC), Buenos Aires, Argentina
| | - José Feijoo
- Argentinian Critical Care Ultrasonography Association (ASARUC), Buenos Aires, Argentina
- Department of critical care medicine, Hospital de Agudos Bernardino Rivadavia, Buenos Aires, Argentina
| | - Francisco Marcelo Tamagnone
- Argentinian Critical Care Ultrasonography Association (ASARUC), Buenos Aires, Argentina
- Department of critical care medicine, Hospital Militar Campo de Mayo, Buenos Aires, Argentina
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Lee JH, Choi HJ, Woo JW, Jung EJ. Robotic versus endoscopic transoral thyroidectomy in papillary thyroid cancer: A comparative analysis of surgical outcomes in 240 consecutive patients. Head Neck 2023; 45:827-837. [PMID: 36606489 DOI: 10.1002/hed.27295] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 11/10/2022] [Accepted: 12/27/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND This study compared the surgical outcomes of transoral endoscopic thyroidectomy vestibular approach (TOETVA) and transoral robotic thyroidectomy (TORT) in papillary thyroid cancer (PTC). METHODS The TOETVA and TORT groups comprised 119 and 121 patients between November 2016 and May 2022. Clinico-surgical outcomes and operation times were retrospectively reviewed. RESULTS The TORT group showed a higher number of retrieved central compartment lymph nodes, shorter hospital stays, and lower pain score after 48 h than the TOETVA group. No significant difference was observed in the other postoperative complications, including permanent vocal cord palsy. Total operation, working space creation, and endoscopic or robotic surgery times of the TORT group were longer than those of the TOETVA group. CONCLUSIONS TORT and TOETVA are feasible and safe. TORT may have some advantages, such as central compartment node dissection, shorter hospital stays, and pain score after 48 h in PTC, despite a longer operative time.
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Affiliation(s)
- Jun Ho Lee
- Department of Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea.,Department of Surgery, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - Hee Jun Choi
- Department of Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Jung-Woo Woo
- Department of Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Republic of Korea
| | - Eun-Jung Jung
- Department of Surgery, Gyeongsang National University College of Medicine, Jinju, Republic of Korea.,Department of Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Republic of Korea
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10
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Wu V, Samargandy S, Philteos J, Pasternak JD, de Almeida JR, Monteiro E. Evaluation of Preference and Utility Measures for Transoral Thyroidectomy. Ann Otol Rhinol Laryngol 2023; 132:381-386. [PMID: 35503808 PMCID: PMC9989232 DOI: 10.1177/00034894221094950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Traditional, trans-cervical thyroidectomy results in the presence of a neck scar, which has been shown to correlate with lower quality of life and lower patient satisfaction. Transoral thyroid surgery (TOTS) has been utilized as an alternative approach to avoid a cutaneous incision and scar by accessing the neck and thyroid through the oral cavity. This study was designed to evaluate patient preference through health-state utility scores for TOTS as compared to conventional trans-cervical thyroidectomy. METHODS In this cross-sectional study, patient preferences were elicited for TOTS and trans-cervical thyroidectomy with the use of an online survey. Respondents were asked to consider 4 hypothetical health scenarios involving thyroid surgery with varying approaches. Health-state utility scores were elicited using visual analog scale and standard gamble exercises. RESULTS Overall, 516 respondents completed the survey, of whom 261 (50.6%) were included for analysis, with a mean age of 41.5 years (SD 14.9 years), including 171 (65.5%) females. Health utility scores were similar for TOTS and conventional transcervical techniques. Statistically significant differences in the standard gamble utility score were noted for gender and ethnicity across all scenarios. Comparisons of visual analog score utilities were not statistically significant based on respondent demographics. CONCLUSION Preferences for TOTS and trans-cervical thyroidectomy did not significantly differ in the current study. Females and white ethnicity indicated stronger preference for a TOTs approach compared to males and other ethnicities, respectively. Some literature suggests certain types of patients who might prefer minimally invasive thyroidectomy more so than other patients-in keeping with the current findings of this study.
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Affiliation(s)
- Vincent Wu
- Department of Otolaryngology-Head & Neck Surgery, Sinai Health, University of Toronto, Toronto, ON, Canada
| | - Shireen Samargandy
- Department of Otolaryngology-Head & Neck Surgery, Sinai Health, University of Toronto, Toronto, ON, Canada
| | - Justine Philteos
- Department of Otolaryngology-Head & Neck Surgery, Sinai Health, University of Toronto, Toronto, ON, Canada
| | - Jesse D Pasternak
- Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - John R de Almeida
- Department of Otolaryngology-Head & Neck Surgery, Sinai Health, University of Toronto, Toronto, ON, Canada.,Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Eric Monteiro
- Department of Otolaryngology-Head & Neck Surgery, Sinai Health, University of Toronto, Toronto, ON, Canada
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11
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Li L, Zhou J, Xu H, Jin Y, Chen X, Carrau RL. Maximal exposure of the parapharyngeal internal carotid artery via transnasal and transoral corridors. Head Neck 2023; 45:757-763. [PMID: 36513521 DOI: 10.1002/hed.27267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 11/21/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The parapharyngeal internal carotid artery (pICA) could be surgically exposed through the transnasal and transoral corridors. However, their potential degree of exposure has not been established sufficiently. This study aims to elucidate the maximal exposure of the pICA via the transnasal and transoral corridors. METHODS An endonasal transpterygoid nasopharyngectomy for exposure of the pICA was performed on eight cadaveric specimens (16 sides), while a transoral approach for exposure of the pICA was performed on six additional specimens (12 sides). In addition, the CT angiography of 60 consecutive patients (120 sides) was analyzed to establish the potential maximal exposure of the pICA through each corridor. RESULTS The hard palate becomes a restricting factor for the inferior exposure of the pICA via the transnasal approach, whereas the entire pICA segment could be adequately displayed through the transoral corridor. The maximal exposed length of the pICA for a transnasal and transoral approach was 3.08 ± 0.30 cm and 6.56 ± 0.57 cm, respectively. This difference was statistically significant (p < 0.001). CONCLUSION An endonasal exposure of the pICA seems limited to its superior aspect, whereas the transoral corridor could provide adequate exposure of the entire length of pICA.
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Affiliation(s)
- Lifeng Li
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Department of Otolaryngology-Head and Neck Surgery, Xianghe People's Hospital, Langfang, Hebei, China
| | - Jing Zhou
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Hongbo Xu
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yonggang Jin
- Department of Otolaryngology-Head and Neck Surgery, Xianghe People's Hospital, Langfang, Hebei, China
| | - Xiaohong Chen
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ricardo L Carrau
- Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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12
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Li P, Qin H, Jin R, Zheng W, Fan P, Lyu PF. The global status and hotspots of research in the field of trans-oral endoscopic thyroidectomy (TOET) from 2008 to 2022. Front Surg 2023; 10:1120442. [PMID: 37181597 PMCID: PMC10174433 DOI: 10.3389/fsurg.2023.1120442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 03/20/2023] [Indexed: 05/16/2023] Open
Abstract
Purpose In this study, the aim was to comprehensively analyze the current status, hotspots, and trends of trans-oral endoscopic thyroidectomy (TOET) through bibliometric analysis and by presenting the field atlas. Methods Web of Science Core Collection database was adopted to screen studies regarding TOET published between January 1, 2008 and August 1, 2022. The evaluation covered the criteria total number of studies, keywords, and contributions from countries/regions, institutions, journals, and authors. Results A total of 229 studies were covered. SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES is the largest publication in the field of TOET. The three countries that contributed the most studies were Korea, China, and the USA. The most frequently occurring core keywords in the field of TOET are vestibular approach, outcomes, experience, safety, robotic thyroidectomy, scar, video-assisted thyroidectomy and quality-of-life. The seven clusters were generated in this study: intraoperative monitoring of the laryngeal return nerve (# 0), learning curve (# 1), postoperative quality of life (# 2), central lymph node dissection and safety (# 3), complications (# 4), minimally invasive surgery (# 5), and robotic surgery (# 6). Conclusion The main research topics in the field of TOET place focuses on learning curves, laryngeal nerve monitoring, carbon dioxide gas bolus, chin nerve injury, surgical complications, and surgical safety. In the future, more academics will focus on the safety of the procedure and reducing complications..
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Affiliation(s)
- Ping Li
- Department of Maxillofacial and Ear, Nose and Throat Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, China
- Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Hao Qin
- Department of Breast Surgery, The First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Rui Jin
- Department of Maxillofacial and Ear, Nose and Throat Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, China
- Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Wuping Zheng
- Department of Thyroid and Breast Surgery, The Second Affiliated Hospital of Hainan Medical University, Haikou, China
- Correspondence: Peng-fei Lyu Pingming Fan Wuping Zheng
| | - Pingming Fan
- Department of Breast Surgery, The First Affiliated Hospital of Hainan Medical University, Haikou, China
- Correspondence: Peng-fei Lyu Pingming Fan Wuping Zheng
| | - Peng-fei Lyu
- Department of Breast Surgery, The First Affiliated Hospital of Hainan Medical University, Haikou, China
- Correspondence: Peng-fei Lyu Pingming Fan Wuping Zheng
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13
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Li L, Xu H, London NR, Carrau RL, Jin Y, Chen X. Endoscopic transoral approach to the lateral poststyloid space. Head Neck 2023; 45:294-301. [PMID: 36333984 DOI: 10.1002/hed.27240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/10/2022] [Accepted: 10/19/2022] [Indexed: 11/08/2022] Open
Abstract
The lateral poststyloid space (LPSS) located at the posterolateral aspect of the styloid process. This study aims to explore the anatomical relationships in LPSS via a transoral corridor, providing reference for addressing lesions extending to this region. An endoscopic transoral approach for exposure of the LPSS was performed on 6 cadaveric specimens (12 sides). Related landmarks were explored, and transoral extirpation of tumors extended into LPSS was employed in 12 patients. The deep lobe of the parotid gland, extratemporal facial nerve, and the accompanying artery in the LPSS were sufficiently exposed via the transoral corridor in all 12 cadaveric sides. The transoral corridor provided adequate exposure for tumors extending to the LPSS, and en bloc resection was achieved in these 12 patients. No facial nerve or vascular injury occurred, and no recurrence observed in this cohort with an average follow-up of 26 months. An endoscopic transoral approach provides a direct access to the LPSS. Appreciation of the anatomical relationships within the LPSS is valuable for employing a transoral extirpation of tumors extending to this specific region.
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Affiliation(s)
- Lifeng Li
- Department of Otolaryngology - Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Hongbo Xu
- Department of Otolaryngology - Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Nyall R London
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Ricardo L Carrau
- Department of Otolaryngology - Head and Neck Surgery, The James Cancer Hospital, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Yonggang Jin
- Department of Otolaryngology - Head and Neck Surgery, Xianghe People's Hospital, Langfang, China
| | - Xiaohong Chen
- Department of Otolaryngology - Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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14
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Sheng X, Liu J, Fang J, Zheng X, Wang S. En bloc resection of total thyroid and bilateral central compartment lymph nodes via a gasless transoral approach in papillary thyroid carcinoma. Front Endocrinol (Lausanne) 2023; 14:1130791. [PMID: 36923227 PMCID: PMC10009257 DOI: 10.3389/fendo.2023.1130791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/08/2023] [Indexed: 03/02/2023] Open
Abstract
INTRODUCTION The current study presents a preliminary exploration of en bloc resection via a gasless transoral approach in papillary thyroid carcinoma. OBJECTIVE This study aimed to summarize and explore the efficacy and safety of en bloc resection of total thyroid and bilateral central compartment lymph nodes via a gasless transoral approach in patients with papillary thyroid carcinoma. METHODS This study was conducted between January 2021 and December 2021. It involved 30 patients with bilateral papillary thyroid carcinoma who had undergone en bloc resection of the total thyroid and bilateral central compartment lymph nodes via a gasless transoral approach using a three-trocar and four-instrument technique at The First Affiliated Hospital of the University of Science and Technology of China. The key steps and difficulties of the operation were summarized, and the clinicopathological characteristics and surgical complications of patients were analyzed. RESULTS All operations were successful without conversion to open surgery. The pathological diagnosis was bilateral papillary thyroid carcinoma. The mean maximum tumor diameter was 0.85 ± 0.51 cm (range 0.3-2.5 cm). There was no case of gross capsular invasion. The mean number of harvested central compartment lymph nodes was 11.36 ± 5.36. Central compartment lymph node metastases were found in 16 patients (53.3%) with a mean of 1.53 ± 2.39. On the other hand, lymphocytic thyroiditis was observed in 12 cases (40%), and microscopic capsular invasion was observed in five cases (16.6%). All patients had normal parathyroid hormone levels after the operation. However, one patient developed hoarseness after the operation due to injury of the recurrent laryngeal nerve branch, but there was no numbness of the mandible and lower lip or infection of the oral incision. CONCLUSION The study revealed that the three-trocar and four-instrument technique can be used in the en bloc resection of total thyroid and bilateral central compartment lymph nodes via a gasless transoral approach without disconnecting the thyroid isthmus. As a result, the operation is considered effective and safe. Therefore, this technique may be a better surgical method for patients with bilateral thyroid cancer and cosmetic needs.
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Affiliation(s)
- Xuren Sheng
- Department of Head and Neck Surgery, West District of The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
- Department of Head and Neck Surgery, Anhui Provincial Cancer Hospital, Hefei, China
| | - Jianjun Liu
- Department of Head and Neck Surgery, West District of The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
- Department of Head and Neck Surgery, Anhui Provincial Cancer Hospital, Hefei, China
| | - Jing Fang
- Department of Head and Neck Surgery, West District of The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
- Department of Head and Neck Surgery, Anhui Provincial Cancer Hospital, Hefei, China
| | - Xucai Zheng
- Department of Head and Neck Surgery, West District of The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
- Department of Head and Neck Surgery, Anhui Provincial Cancer Hospital, Hefei, China
| | - Shengying Wang
- Department of Head and Neck Surgery, West District of The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
- Department of Head and Neck Surgery, Anhui Provincial Cancer Hospital, Hefei, China
- *Correspondence: Shengying Wang,
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15
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Karakas E, Klein G, Schopf S. Transoral thyroid surgery vestibular approach. Innov Surg Sci 2022; 7:107-113. [PMID: 36561507 PMCID: PMC9742272 DOI: 10.1515/iss-2021-0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/01/2021] [Indexed: 12/25/2022] Open
Abstract
Objectives Transoral thyroid surgery vestibular approach (TOETVA) is a novel and feasible surgical technique that allows for cervical surgery without visible incisions. TOETVA represents a new frontier in endocrine surgery since aesthetic results play a more and more decisive role in elective surgery. However, acceptance is different around the world with widespread prevalence in Asian countries and some high-volume centres in the US. While inclusion criteria for TOETVA are limited regarding size and volume a combination with other extracervical techniques like the retroauricular endoscopic cephalic access thyroid surgery (EndoCATS) approach or transaxillary access is an option. Methods TOETVA is carried out through a three-port technique placed at the oral vestibule. Originally one 10-mm port for a 30° endoscope and two additional 5-mm ports for dissecting and coagulating instruments are used. Alternatively, one 5-mm and one or two 3 mm ports can be used. CO2 insufflation pressure is set at 6 mmHg. An additional device to optimize gas outflow for optimum view might be helpful. An anterior cervical subplatysmal space is created by hydrodissection from the oral vestibule to the sternal notch, laterally to the sternocleidomastoid muscle. Conventional endoscopic instruments are used. Combination of TOETVA with a modified retroauricular access includes insertion of a 10-12 mm trocar placed subcutaneously via a skin incision on the scalp, behind the ear by blunt dissection. Results Since Anuwong published the first case series of 60 patients who underwent scarless thyroidectomy via the lower vestibule of the mouth with excellent results in 2016 almost 1,000 cases are reported in literature to date with comparable results especially regarding traditional complications. In contrast to other extracervical approaches, areolar or axillary for example, the transoral access route is short and the dissection planes are rather like transcervical surgery. Surgical indications and contraindications have been modified since its first description and are partly institution specific to date. To amend indications combination with other extracervical techniques is an option. In addition, patients must carefully be selected for and surgeons` candidacy is of utmost importance in transoral surgery. Conclusions Transoral surgery will likely continue to gain attraction as surgeons become more experienced with the technique. With increased operative use and surgeon experience the gap in conventional outcomes between transoral surgery and the transcervical approach will narrow, with both operative time and the incidence of specific complications diminishing. Experience in thyroid and endoscopic surgery is required to achieve excellent results with low complication rates. However, the new transoral technique is related to novel complications that must be evaluated.
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Affiliation(s)
- Elias Karakas
- Dept. of General-, Abdominal- and Endocrine Surgery, Hospital Maria Hilf, Alexianer GmbH, Krefeld, Germany
| | - Günther Klein
- Dept. of General Surgery, Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria
| | - Stefan Schopf
- Dept. of General-, Abdominal- and Endocrine Surgery, RoMed Hospital, Bad Aibling, Germany
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16
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Cadena‐Piñeros E, Moreno‐Torres A, Correa‐Marin J, Melo‐Uribe MA. Transoral robotic surgery for parapharyngeal carcinoma ex-pleomorphic adenoma: A case report. Cancer Rep (Hoboken) 2022; 5:e1692. [PMID: 35945155 PMCID: PMC9675383 DOI: 10.1002/cnr2.1692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 07/25/2022] [Accepted: 07/27/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Carcinoma ex-pleomorphic adenoma (Ca ex-PA) comprises 0.5% of head and neck neoplasms. Transoral robotic surgery (TORS) is an approach being used to treat a variety of benign and malignant head and neck neoplasms. Recently, this technique has gained popularity as an alternative for parapharyngeal space (PPS) tumor resection. To our knowledge, this is the first case of Ca ex-PA managed successfully by TORS of the PPS. CASE Fifty-nine-year-old male with incidental mass in PPS, initial diagnosis of pleomorphic adenoma, who underwent transoral robotic resection. The histopathology diagnosis with minimally invasive Ca ex-PA findings and malignant component of high-grade epithelial/myoepithelial carcinoma and salivary duct carcinoma. Patient discharged on the fifth post-operative day without complications. CONCLUSION Based on our findings, TORS may be a safe procedure to remove selected Ca ex-PA from the PPS; however, further research is needed.
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Affiliation(s)
- Enrique Cadena‐Piñeros
- Department of Head and NeckInstituto Nacional de CancerologíaBogotáDCColombia,Department of OtorhinolaryngologyUniversidad Nacional de Colombia and Hospital Universitario Nacional de ColombiaBogotáDCColombia
| | - Andrey Moreno‐Torres
- Department of Head and NeckInstituto Nacional de CancerologíaBogotáDCColombia,Department of SurgeryCínica CountryBogotáDCColombia
| | | | - Mario A. Melo‐Uribe
- Department of PathologyInstituto Nacional de CancerologíaBogotáDCColombia,Department of PathologyFundación Universitaria de Ciencias de la SaludBogotáDCColombia
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17
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Li L, Xu H, London NR, Carrau RL, Jin Y, Chen X. Endoscopic trans-lateral oropharyngeal wall approach to the petrous apex and the petroclival region. Head Neck 2022; 44:2633-2639. [PMID: 35866311 DOI: 10.1002/hed.27156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 06/19/2022] [Accepted: 07/07/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND A trans-lateral oropharyngeal wall approach (TLOWA) to the petrous apex has not been previously defined. This study aims to assess the feasibility of a TLOWA for surgical access to the petrous apex and the petroclival region. METHODS An endoscopic TLOWA for exposure of the petrous apex and petroclival region was performed on five cadaveric specimens (10 sides). Associated anatomical landmarks were defined, and the strategies for maximal exposure of the internal carotid artery (ICA) were explored. RESULTS Via a TLOWA, the parapharyngeal ICA was widely exposed in all 10 sides. Following transection of the Eustachian tube, the inferior petrous apex and petroclival region could be sufficiently exposed. After drilling the anteroinferior bony canal, the horizontal petrous ICA, foramen lacerum, and the paraclival ICA could be adequately revealed. CONCLUSION The TLOWA may provide an alternative corridor for access to the petrous apex and the petroclival region. The parapharyngeal, petrous, lower paraclival ICAs, and the foramen lacerum could be adequately exposed via the TLOWA.
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Affiliation(s)
- Lifeng Li
- Department of Otolaryngology-Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Hongbo Xu
- Department of Otolaryngology-Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Nyall R London
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Ricardo L Carrau
- Department of Otolaryngology-Head & Neck Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University, Columbus, Ohio, USA
| | - Yonggang Jin
- Department of Otolaryngology-Head and Neck Surgery, Xianghe People's Hospital, Hebei, China
| | - Xiaohong Chen
- Department of Otolaryngology-Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
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18
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Li L, Xu H, Jin Y, Chen X, Carrau RL, London NR. Exploration of anatomical landmarks for performing an endoscopic transoral nasopharyngectomy. Head Neck 2022; 44:2378-2385. [PMID: 35818842 DOI: 10.1002/hed.27148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/18/2022] [Accepted: 06/28/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Performing a nasopharyngectomy via a transoral approach has been reported; however, defining landmarks to facilitate this approach has not been addressed. This study aims to explore anatomical landmarks to aid in performing a nasopharyngectomy via the transoral corridor. METHODS An endoscopic transoral nasopharyngectomy was performed on six cadaveric specimens (12 sides). Related anatomical landmarks were defined, and the strategy to preserve the parapharyngeal internal carotid artery (pICA) was explored. RESULTS An endoscopic transoral nasopharyngectomy was successfully achieved in all 12 sides. Utilizing the pterygoid hamulus as a landmark, the cartilaginous ET and attachments could be adequately exposed. Identification of the pICA is a prerequisite prior to Eustachian tube (ET) transection. The sphenoidal spine and the petrotympanic fissure could be sufficiently revealed in all 12 sides, which aided in transection of the cartilaginous ET without pICA injury. The ET and the prevertebral contents could be adequately removed via the transoral corridor. CONCLUSION The pterygoid hamulus, sphenoidal spine and petrotympanic fissure serve as reliable landmarks for performing a transoral nasopharyngectomy. Identification of the pICA is a prerequisite prior to transection of the ET to avoid pICA injury.
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Affiliation(s)
- Lifeng Li
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Hongbo Xu
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yonggang Jin
- Department of Otolaryngology-Head and Neck Surgery, Xianghe People's Hospital, Hebei, China
| | - Xiaohong Chen
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ricardo L Carrau
- Department of Otolaryngology-Head & Neck Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University, Columbus, Ohio, USA
| | - Nyall R London
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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19
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Li L, Xu H, London NR, Carrau RL, Jin Y, Chen X. Transoral Approach to the Jugular Foramen Region with Preservation of the Eustachian Tube. Laryngoscope 2022; 132:1374-1380. [PMID: 35297505 DOI: 10.1002/lary.30077] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/06/2022] [Accepted: 02/14/2022] [Indexed: 01/22/2023]
Abstract
OBJECTIVES/HYPOTHESIS Transnasal exposure of the jugular foramen region (JFR) often requires transection of the Eustachian tube (ET). This study aims to propose a transoral corridor for access to the JFR with preservation of the ET. STUDY DESIGN Cadaveric dissection and case illustration. METHODS An endoscopic transoral approach for exposure of the JFR was performed on 5 cadaveric specimens (10 sides). Six patients who underwent a transoral resection of schwannoma within the JFR were retrospectively analyzed. RESULTS Direct exposure of the JFR with a 0° scope via a transoral approach was feasible, and the internal carotid artery and lower cranial nerves could be adequately exposed, and preservation of the ET was achieved in all 10 sides of the cadaveric specimens. For six patients with JFR tumors, the transoral approach provided adequate access to achieve a gross total resection with ET preservation. Intraoperative cerebral spinal fluid (CSF) leak was encountered in one patient, and a multilayer reconstruction was employed for reconstruction. No operative field or intracranial infection, persistent CSF leak, or emergent airway issues occurred. No recurrence occurred in this cohort with an average follow-up of 12 months. CONCLUSIONS The transoral approach provided a reliable corridor for access into the JFR with preservation of the ET. For select lesions with expansion into the posterior cranial fossa, a transoral corridor may serve as an alternative for tumor extirpation. LEVEL OF EVIDENCE 4 Laryngoscope, 2022.
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Affiliation(s)
- Lifeng Li
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Hongbo Xu
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Nyall R London
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A
| | - Ricardo L Carrau
- Department of Otolaryngology-Head & Neck Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University, Columbus, Ohio, U.S.A
| | - Yonggang Jin
- Department of Otolaryngology-Head and Neck Surgery, Xianghe People's Hospital, Langfang, China
| | - Xiaohong Chen
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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20
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Li L, London NR, Li S, Chen X, Carrau RL. Endoscopic Transoral Approach for Resection of Basal Cell Adenoma Arising in Parapharyngeal Space. J Neurol Surg B Skull Base 2021; 82:675-681. [PMID: 34745836 DOI: 10.1055/s-0040-1715574] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 06/11/2020] [Indexed: 02/02/2023] Open
Abstract
Objectives The clinical and radiological characteristics of the basal cell adenoma (BCA) and its association with the internal carotid artery (ICA) in the parapharyngeal space (PPS), have not been sufficiently explored. This study aims to analyze the characteristics of patients with BCA arising in the PPS and to evaluate the feasibility of a total resection via an endoscopic transoral corridor. Design and Main Outcome Measures The clinical, radiological, and histopathological characteristics of four patients with BCA arising in the PPS were retrospectively analyzed. The endoscopic transoral approach was performed for resection of BCA. Its technical nuances, perioperative comorbidities, and outcomes are introduced. Results The clinical presentation, symptoms, and signs of patients with BCA are variable. The tumor was lateral to the ICA in two patients and anterior to the ICA in the remaining two. All four BCA were successfully removed en bloc ( n = 3) or by piecemeal ( n = 1) via an endoscopic transoral approach. The ICA was not injured, and no additional nerve damage, venous bleeding, postoperative infection, or salivary gland fistula were encountered in any of the four patients. Cystic degeneration is the predominant appearance of BCA on MRI; however, they are difficult to differentiate from other lesions arising in the PPS. No recurrence was detected at the time of the study analysis. Conclusion BCA of the PPS could have variable relationships with the ICA. An endoscopic transoral approach can provide an adequate corridor for total resection of BCA in PPS with seemingly low morbidity.
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Affiliation(s)
- Lifeng Li
- Department of Otolaryngology-Head & Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Nyall R London
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, United States.,Sinonasal and Skull Base Tumor Program, National Institute on Deafness and Other Communication Disorders, NIH, Bethesda, Maryland, United States
| | - Shuling Li
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xiaohong Chen
- Department of Otolaryngology-Head & Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Ricardo L Carrau
- Department of Otolaryngology-Head & Neck Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University, Columbus, Ohio, United States
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21
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D'Ortenzio R, Tolhurst S, Harvey M, Ghag R, Heran MK. The CT guided transoral approach: A biopsy technique for a poorly differentiated chordoma in a 5 year old. J Radiol Case Rep 2021; 15:1-8. [PMID: 34267865 DOI: 10.3941/jrcr.v15i3.4208] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Mass lesions presenting at the craniocervical junction often present a unique challenge due to the complex anatomic arrangement limiting access for tissue diagnosis. The transoral approach has predominantly been used for percutaneous vertebroplasty of high cervical vertebrae with limited literature describing image guided biopsy for bony lesions in this region in the pediatric patient. We describe a technique of computed tomography guided transoral biopsy of a poorly differentiated chordoma located at the C1-C2 level in a 5-year-old child, and review this diagnosis.
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Affiliation(s)
- Robert D'Ortenzio
- Department of Radiology, Vancouver General Hospital, Vancouver, Canada
| | - Stefano Tolhurst
- Department of Radiology, Vancouver General Hospital, Vancouver, Canada
| | - Melissa Harvey
- Department of Pediatrics, BC Children's Hospital, Vancouver, Canada
| | - Ravi Ghag
- Department of Orthopaedics, BC Children's Hospital, Vancouver, Canada
| | - Manraj Ks Heran
- Department of Radiology, BC Children's Hospital, Vancouver, Canada
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22
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Power AM, Diamond DW, Puetthoff C. Laparotomy-Assisted Transoral Foreign Body Retrieval in Small Animals: 10 Cases (2018-2020). Top Companion Anim Med 2020; 42:100504. [PMID: 33346163 DOI: 10.1016/j.tcam.2020.100504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 11/23/2020] [Accepted: 12/14/2020] [Indexed: 10/22/2022]
Abstract
Small intestinal foreign bodies can often be manually manipulated orad into the stomach, or aborad into the colon during exploratory laparotomy. While the former allows for gastrotomy in lieu of enterotomy, the latter obviates need for incision in the gastrointestinal tract altogether. In this report, we provide novel description of a technique to remove foreign material from the stomach per os following extraluminal manipulation during surgery. This is achieved using a grasping instrument introduced via orogastric tube. The described laparotomy-assisted transoral foreign body retrieval is an effective alternative to gastrotomy in certain cases. This technique is less invasive and may be associated with shorter operative time and decreased morbidity compared to procedures requiring incision into the gastrointestinal tract.
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23
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Abstract
The surgical treatment of oropharyngeal squamous cell carcinoma (OSCC) has undergone a considerable evolution, with, among others, transoral robotic surgery (TORS). However, TORS is rarely used for the surgery of soft palate. A 73-year-old man presented a human papilloma virus OSCC of the posterior soft palate. The tumor was resected using TORS. This report describes the surgical technique step by step of the tumor resection. The resection of early stage OSCC of the posterior surface of soft palate is possible through TORS. The procedure is noninvasive, rapid, and seems to be associated with excellent functional outcomes.
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Affiliation(s)
- Emilien Chebib
- Robotic Study Group of Young Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Marseille, France.,Department of Otorhinolaryngology and Head and Neck Surgery, 37918Foch 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), Marseille, France.,Department of Otorhinolaryngology and Head and Neck Surgery, 37918Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Younes Chekkoury
- Robotic Study Group of Young Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Marseille, France.,Department of Otorhinolaryngology and Head and Neck Surgery, 37918Foch 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), Marseille, France.,Department of Otorhinolaryngology and Head and Neck Surgery, 37918Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
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24
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Visocchi M, Mattogno PP, Ciappetta P, Barbagallo G, Signorelli F. Combined transoral exoscope and OArm-assisted approach for craniovertebral junction surgery: Light and shadows in single-center experience with improving technologies. J Craniovertebr Junction Spine 2020; 11:293-299. [PMID: 33824559 PMCID: PMC8019117 DOI: 10.4103/jcvjs.jcvjs_176_20] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 10/15/2020] [Indexed: 11/04/2022] Open
Abstract
Background The introduction of recent innovations in the field of intraoperative imaging and neuronavigation, such as OArm Stealth Station, allows to obtain crucial intraoperative data by performing safer and controlled surgical procedures. As part of the improvement of surgical visual magnification and wide expansion of surgical corridors, the 3D-4K exoscope (EX) represents nowadays an interesting and useful tool. Transoral approach (TOA) represents the historical gold standard direct microsurgical route to ventral craniovertebral junction (CVJ). Methods We herein report a preliminary experience on 6 cases of 33 patients operated by TOA concerning the simultaneous application of OArm with Stealth Navigation system (Medtronic, Memphis, TN) and imaging system along with the 3D-4K EXs in TOA for the treatment of CVJ pathologies. Results Neither intraoperative neurophysiological changes nor postoperative infections occurred, but a neurological improvement was evident in all the patients. A complete decompression along with stable instrumentation and fusion of the CVJ was accomplished in all cases at the maximum follow-up (mean: 16.8 months). Conclusions With EX, the role of surgeon become self-sufficient with a better individual surgical freedom compared to endoscopic surgery and excellent 3D vision and magnification. OArm allows an absolutely reliable intraoperative support for a more effective CVJ decompression. Nevertheless, with OArm-assisted neuronavigation, it can be difficult to navigate C1 lateral masses and C2 isthmi, and to convert 3D into 2D real-time navigation, it can become quite complicate. Finally, the association of EX and OArm appears more time consuming compared to the old fashion one.
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Affiliation(s)
- Massimiliano Visocchi
- Institute of Neurosurgery, Operative Unit, Research Center and Master II Degree Surgical Approaches Craniovertebral Junction, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
| | - Pier Paolo Mattogno
- Institute of Neurosurgery, Operative Unit, Research Center and Master II Degree Surgical Approaches Craniovertebral Junction, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
| | | | - Giuseppe Barbagallo
- Departement of Neurological Surgery, Policlinico Gaspare Rodolico University Hospital, Catania, Italy
| | - Francesco Signorelli
- Institute of Neurosurgery, Operative Unit, Research Center and Master II Degree Surgical Approaches Craniovertebral Junction, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
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25
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Fu Y, Wu M, Fu J, Lin S, Song Z, Chen J, Yan W, Kuang P, Lin F, Luo Y, Lin E, Hong X, Wu G. TransOral Endoscopic Thyroidectomy via Submental and Vestibular Approach: A Preliminary Report. Front Surg 2020; 7:591522. [PMID: 33330608 PMCID: PMC7719628 DOI: 10.3389/fsurg.2020.591522] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/28/2020] [Indexed: 12/30/2022] Open
Abstract
Purpose: Transoral endoscopic thyroidectomy via vestibular approach (TOETVA), with its excellent cosmetic effect, has become increasingly popular worldwide. Nonetheless, anatomic obstacles have limited its development to a certain extent. Here, we present our preliminary outcomes of transoral endoscopic thyroidectomy via submental and vestibular approach (TOETSMVA), which can overcome those limitations. Methods: From November 2019 to March 2020, we performed TOETSMVA in 21 consecutive patients with thyroid carcinoma at Zhongshan Hospital, Xiamen University. A 1.5-cm lateral incision was made at two fingers below the mandible; two 5-mm incisions were made in the vestibule near the first molars; TOETSMVA was completed through these incisions. The demographic data and surgical outcomes of the patients were retrospectively reviewed. Results: Twenty-one patients with a mean age of 37.5 ± 10.4 years were incorporated into this study. Fourteen patients had papillary thyroid micro-carcinomas, two had papillary thyroid carcinomas, and five had benign nodules. Eight patients had lymph node metastases. All surgeries were performed successfully without conversion to open thyroidectomy. The mean operation time was 138.8 ± 33.2 min; the average hospital stay was 3.3 ± 0.8 days. No patients developed cutaneous paralysis in the midline chin region. Transient recurrent laryngeal nerve paralysis was observed in one patient. There was no evidence of postoperative bleeding, infection, tetany, or other complications. Conclusion: TOETSMVA was shown to be a safe and advisable alternative for selected patients. This approach can overcome the limitations of TOETVA without sacrificing cosmetic results.
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Affiliation(s)
- Yilong Fu
- Department of General Surgery, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Mengwei Wu
- Depatment of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jinbo Fu
- Department of General Surgery, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Suqiong Lin
- Department of General Surgery, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Zhengfu Song
- Department of General Surgery, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Jiyu Chen
- Department of General Surgery, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Wei Yan
- Department of General Surgery, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Penghao Kuang
- Department of General Surgery, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Fusheng Lin
- Department of General Surgery, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Yezhe Luo
- Department of General Surgery, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Ende Lin
- Department of General Surgery, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Xiaoquan Hong
- Department of General Surgery, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Guoyang Wu
- Department of General Surgery, Zhongshan Hospital, Xiamen University, Xiamen, China
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26
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Abstract
Background: The transoral endoscopic approach to the central neck has rapidly become one of the most widely utilized remote-access approaches for thyroid and parathyroid surgery in the world. The approach involves three small incisions inside the lower lip and has an optimal cosmetic outcome with no visible scar. However, the technique is quite difficult and poses several challenges that limit its widespread adoption. To overcome these issues, a novel lateral vestibular approach (LaVA) was explored in cadavers. Methods: Study using 7 fresh human cadavers that were dissected using open and endoscopic techniques to explore the feasibility of a transoral vestibular approach to the central neck without gas insufflation. Results: This novel approach resulted in wide access to the central neck and allowed for a total thyroidectomy and central neck dissection while preserving the marginal mandibular and mental nerves. Conclusions: LaVA permits excellent access to the central neck with a wide working space without the need for gas insufflation and overcomes many of the limitations of current transoral endoscopic approaches to the central neck.
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Affiliation(s)
- Jeremy D Richmon
- Massachusetts Eye and Ear, Harvard University, Boston, Massachusetts, USA
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27
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Khafif A, Cohen O, Masalha M, Yaish I, Hod K, Assadi N. Adoption of the transoral endoscopic vestibular approach by head and neck surgeons without prior laparoscopic/robotic experience. Head Neck 2020; 43:496-504. [PMID: 33006207 DOI: 10.1002/hed.26503] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 09/12/2020] [Accepted: 09/24/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Transoral endoscopic vestibular approach (TOEVA) for thyroidectomy (TOETVA) and parathyroidectomy (TOEPVA) is gaining popularity, yet knowledge is based on a limited number of studies, mostly performed by surgeons experienced in laparoscopic\robotic surgery. METHODS All patients who underwent TOEVA at our institution between February 2018 and October 2019 were followed prospectively. Main outcomes were ability to accomplish surgery endoscopically (failure defined as conversion to open approach) and complications. RESULTS Seventy-one patients (52 TOETVA and 19 TOEPVA) were included. 98% (51/52) and 100% (19/19) of TOETVA and TOEPVA surgeries were accomplished endoscopically, respectively. Transient vocal cord and mental nerve injuries rates were 8.4% (6/71) and 2.8% (2/71), respectively. Thyroid carcinoma was diagnosed in 27 patients (51.9%), all completely excised with clean margins. CONCLUSIONS Adoption of the TOEVA suggested framework by head and neck surgeons without prior experience in laparoscopic/robotic techniques is feasible resulting in nearly 100% of surgeries accomplished endoscopically.
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Affiliation(s)
- Avi Khafif
- ARM - Center for Otolaryngology - Head and Neck Surgery and Oncology, Assuta Medical Center, Tel Aviv, Affiliated with Ben Gurion University, Beer Sheva, Israel
| | - Oded Cohen
- ARM - Center for Otolaryngology - Head and Neck Surgery and Oncology, Assuta Medical Center, Tel Aviv, Affiliated with Ben Gurion University, Beer Sheva, Israel
| | - Muhamed Masalha
- ARM - Center for Otolaryngology - Head and Neck Surgery and Oncology, Assuta Medical Center, Tel Aviv, Affiliated with Ben Gurion University, Beer Sheva, Israel.,Department of Otolaryngology, Head and Neck Surgery, Emek Medical Center, Technion University, Haifa, Israel
| | - Iris Yaish
- ARM - Center for Otolaryngology - Head and Neck Surgery and Oncology, Assuta Medical Center, Tel Aviv, Affiliated with Ben Gurion University, Beer Sheva, Israel.,Endocrine Institute, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Keren Hod
- Department of Academy and Research, Assuta Medical Centers, Tel Aviv, Affiliated with Ben Gurion University, Beer Sheva, Israel
| | - Niddal Assadi
- ARM - Center for Otolaryngology - Head and Neck Surgery and Oncology, Assuta Medical Center, Tel Aviv, Affiliated with Ben Gurion University, Beer Sheva, Israel
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28
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Mora F, Carta F, Missale F, Laborai A, Parrinello G, Piazza C, Puxeddu R, Peretti G. Laryngeal Mid-Cord Erythroleukoplakias: How to Modulate the Transoral CO 2 Laser Excisional Biopsy. Cancers (Basel) 2020; 12:E2165. [PMID: 32759787 DOI: 10.3390/cancers12082165] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/29/2020] [Accepted: 07/30/2020] [Indexed: 12/17/2022] Open
Abstract
Background: The endoscopic appearance of glottic erythroleukoplakias is non-predictive of their histopathology, potentially ranging from keratosis to invasive squamous cell carcinoma (SCC). The aim of this study was to assess a comprehensive workup for the one-step diagnosis and treatment of mid-cord erythroleukoplakias, using CO2 laser excisional biopsy. Methods: We evaluated 147 untreated patients affected by 155 mid-cord erythroleukoplakias submitted to excisional biopsy by subepithelial (Type I) or subligamental cordectomy (Type II), across two academic institutions. Patients were evaluated by preoperative videolaryngostroboscopy, pre- and intraoperative videoendoscopy with biologic endoscopy (narrow band imaging, NBI, or the Storz professional image enhancement system, SPIES), either with or without intraoperative saline infusion into the Reinke’s space. Adequacy of treatment was the primary outcome. Results: The histopathologic diagnosis was keratosis in 26 (17%) cases, squamous intraepithelial neoplasia (SIN1-2) in 47 (30%), carcinoma in situ in 21 (14%), and SCC in 61 (39%) patients. The adequacy of treatment across the entire cohort was 89%. The intraoperative saline infusion procedure, facing not clearly suspicious lesions, raised the adequacy of treatment from 60% to 90% (p = 0.006). Conclusions: Excisional biopsy by Type I–II cordectomies, after a comprehensive diagnostic workup, should be accepted as an adequate and cost-effective treatment of unilateral mid-cord glottic erythroleukoplakias.
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29
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Hans S, Chekkoury-Idrissi Y, Circiu MP, Distinguin L, Crevier-Buchman L, Lechien JR. Surgical, Oncological, and Functional Outcomes of Transoral Robotic Supraglottic Laryngectomy. Laryngoscope 2020; 131:1060-1065. [PMID: 32812245 DOI: 10.1002/lary.28926] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 06/09/2020] [Accepted: 06/17/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS To investigate the surgical, oncological, and functional outcomes of transoral robotic surgery (TORS) for the treatment of supraglottic squamous cell carcinoma. STUDY DESIGN Retrospective chart review. METHODS The charts of patients treated by TORS supraglottic laryngectomy (SGL) in an academic medical center were reviewed. The following outcomes were studied according to the tumor location: average robotic setup and operative times, mean estimated blood loss, postoperative complications, need of tracheotomy, refeeding characteristics, mean hospital stay, need of neck dissection and adjuvant therapy, 5-year local and regional controls, overall survival (OS), and disease-free survival (DFS). RESULTS Seventy-five patients underwent TORS SGL. Tumors were classified as cT1 (32%), cT2 (52%), and cT3 (16%). Average robotic setup and operative times and the mean estimated blood loss were 15 minutes, 55 minutes, and 20 mL, respectively. The mean follow-up period ranged from 2 to 5 years. The 5-year OS and DFS were 80.2% and 94.3%, respectively. Overall, 34.6% of patients received adjuvant radiotherapy. The majority of patients (92%) restarted an oral diet within 24 to 48 hours postsurgery. Transient tracheotomy was performed in 8% of patients. Postoperative hemorrhages occurred in 12 patients (16.0%), lengthening the hospital stay (mean = 6.8 days). There were no outcome differences regarding the tumor location. CONCLUSIONS TORS is an effective and safe therapeutic approach for early- and intermediate-stages cancers. Oncological outcomes may be quite similar to other surgical approaches, including transoral laser and open surgeries. Future randomized controlled studies are needed for comparing TORS SGL with other surgical procedures. LEVEL OF EVIDENCE 4 Laryngoscope, 131:1060-1065, 2021.
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Affiliation(s)
- Stéphane Hans
- Robotic Study Group of Young-Otolaryngologists of the International Federations of Otorhinolaryngological Societies (YO-IFOS), Paris, France.,Department of Otorhinolaryngology-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 Otorhinolaryngological Societies (YO-IFOS), Paris, France.,Department of Otorhinolaryngology-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 Otorhinolaryngological Societies (YO-IFOS), Paris, France.,Department of Otorhinolaryngology-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 Otorhinolaryngological Societies (YO-IFOS), Paris, France.,Department of Otorhinolaryngology-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 Otorhinolaryngological Societies (YO-IFOS), Paris, France.,Department of Otorhinolaryngology-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 Otorhinolaryngological Societies (YO-IFOS), Paris, France.,Department of Otorhinolaryngology-Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France.,Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium
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30
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kalantari F, Rajaeih S, Daneshvar A, Karbasi Z, Mahdi Salem M. Robotic surgery of head and neck cancers, a narrative review. Eur J Transl Myol 2020; 30:8727. [PMID: 32782756 PMCID: PMC7385690 DOI: 10.4081/ejtm.2019.8727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 12/29/2019] [Indexed: 02/02/2023] Open
Abstract
Head and neck cancers are the most common cancers in the body. Treatments are determined on the basis of the location and stage of the primary tumor. The goal of treatment is to eliminate the tumor, prevent recurrence or metastasis, and maintain the quality of life. There are several treatments available for the management of head and neck cancers, including surgery, radiation therapy, chemotherapy, new molecular agents, and a combination of them. Transoral robotic technique is a short-time operation using a type of robotic machine in which the patient undergoes anesthesia for a shorter time and the side effects of this operation and the time of hospitalization are less than open surgery. Due to the importance of speed and accuracy in head and neck cancer surgery and the importance of application of robotics in surgery, the present study was designed and implemented to review the application of robotics in the management of head and neck cancers. In this review study, the keywords: application, robotic, surgical, head cancer, transoral robotic surgery (TORS), and neck cancer, were searched in ISI, PubMed, Scopus, Google scholar databases. Related articles written domestically or abroad that have covered areas such as the background of transoral robotic surgery, maintaining organ function and approaches, the advantages and disadvantages of TORS, the affordability of TORS, the combination of TORS with other therapeutic approaches published from 2003 to 2019 were reviewed. The use of robotic surgery for precise operations such as head and neck cancers seems to be essential. More advanced robotic devices are expected to expand the surgery treatment for head and neck cancers as well as the results of using TORS for oncologic optimization and acceptability of results while maintaining organ function and patient's quality of life.
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Affiliation(s)
- Farbood kalantari
- ENT and Head and Neck Research Center and Department, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran
- Skull Base Research Center, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Shahin Rajaeih
- ENT and Head and Neck Research Center and Department, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran
- Skull Base Research Center, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Daneshvar
- ENT and Head and Neck Research Center and Department, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran
- Skull Base Research Center, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Karbasi
- ENT and Head and Neck Research Center and Department, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran
- Skull Base Research Center, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Mahdi Salem
- ENT and Head and Neck Research Center and Department, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran
- Skull Base Research Center, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran
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Abstract
OBJECTIVE Thyroglossal duct cysts (TGDCs) are relatively common congenital midline neck masses that are treated with surgical excision. Traditionally these are removed along with any associated tract and the central portion of the hyoid bone through an anterior neck incision. Some patients with TGDCs want to avoid an external neck scar. METHODS We describe the details of a transoral endoscopic vestibular excision of a TGDC and the associated hyoid bone in an adolescent patient. RESULTS This novel approach was successful and there were no complications. CONCLUSION We propose that cervical TGDCs can be safely and completely removed with this approach in appropriately selected patients while avoiding a neck scar.
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Affiliation(s)
- Marisa A Ryan
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Jonathon O Russell
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Desi P Schoo
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Patrick A Upchurch
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Jonathan M Walsh
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, USA
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Kim WW, Park CS, Lee J, Jung JH, Park HY, Tufano RP. Real Scarless Transoral Robotic Thyroidectomy Using Three Ports Without Axillary Incision. J Laparoendosc Adv Surg Tech A 2020; 30:1165-1171. [PMID: 32301645 DOI: 10.1089/lap.2020.0102] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Introduction: Conventional transoral robotic thyroidectomy (TORT) requires an axillary incision and additional flap dissection. This study aimed to outline the first ever experiences with TORT using three ports without axillary incision and compare the results between three-port and four-port TORT. Materials and Methods: A total of 100 consecutive patients were enrolled. The study sample comprised 47 patients who underwent four-port TORT from November 2016 to June 2017, and 53 patients who underwent three-port TORT from September 2018 to June 2019. The indication of the three-port TORT was the anterior/posterior length of the thyroid <1.8 cm and mass size <1.5 cm. Results: Operative time (minutes) was shorter in the three-port group (166.3 ± 35.4 versus 138.5 ± 34.4, P = .005). Hospital stay (days) was also shorter in the three-port group (3.8 ± 0.4 versus 2.4 ± 0.6, P = .003). TORT using three ports yielded a higher cosmetic satisfaction (3.68 ± 0.52 versus 3.89 ± 0.30, P = .002). Postoperative complications, level of calcium, parathyroid hormone, and pain were not significantly different between the groups. Conclusions: Our study showed that three-port TORT was associated with a shorter operative time, hospital stay, and excellent cosmesis than the conventional four-port option. In conclusion, TORT using three ports is a comparable and an effective operation method as a real scarless operation.
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Affiliation(s)
- Wan Wook Kim
- Department of Surgery, Kyungpook National University, School of Medicine, Daegu, Korea
| | - Chan Sub Park
- Department of Surgery, Kyungpook National University, School of Medicine, Daegu, Korea
| | - Jeeyeon Lee
- Department of Surgery, Kyungpook National University, School of Medicine, Daegu, Korea
| | - Jin Hyang Jung
- Department of Surgery, Kyungpook National University, School of Medicine, Daegu, Korea
| | - Ho Yong Park
- Department of Surgery, Kyungpook National University, School of Medicine, Daegu, Korea
| | - Ralph P Tufano
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Xu Z, Song J, Wang Y, Tan L, Sun S, Meng Y. A comparison of transoral vestibular and bilateral areolar endoscopic thyroidectomy approaches for unilateral papillary thyroid microcarcinomas. Wideochir Inne Tech Maloinwazyjne 2019; 14:501-8. [PMID: 31908695 DOI: 10.5114/wiitm.2019.84759] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 04/17/2019] [Indexed: 12/15/2022] Open
Abstract
Introduction A transoral (TO) vestibular approach is a new remote access approach to avoid cutaneous scars in an endoscopic thyroidectomy (ET). And transoral endoscopic thyroidectomy (TOET) has been widely used in papillary thyroid microcarcinomas (PTMCs). Aim To evaluate and compare endoscopic thyroidectomies with central neck dissection using a bilateral areolar (BA) approach and TO approach in patients with unilateral PTMCs. Material and methods In total, 92 papillary thyroid cancer (PTC) patients undergoing an endoscopic unilateral thyroidectomy with central neck dissection via a TO (n = 48) or BA (n = 44) approach were retrospectively enrolled from August 2017 to December 2018. Differences in various factors, such as clinical characteristics, surgery-related parameters, including operative complications, and hospital durations and costs, were compared. Results No significant between-group differences in the age and sex of the patients or the side, body mass index, total operative time, operative bleeding, superior parathyroid preservation in situ, operative complications, and postoperative day of discharge were found (all p > 0.05). The mean central neck dissection time, amount of postoperative drainage, extubation time, and inferior parathyroid preservation in situ were lower in the TO group as compared with these parameters in the BA group (all p < 0.05). The number of central lymph nodes resected and hospitalization costs were higher in the TO group as compared with those in the BA group (all p < 0.05). Conclusions An ET via the TO approach may be a good choice for unilateral PTMCs because of the shorter central neck dissection time, reduced postoperative drainage, better cosmetic satisfaction, and higher number of lymph nodes removed.
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Yeh MY, Huang WC, Wu JC, Kuo CH, Chang HK, Tu TH, Chang PY, Yen YS, Cheng H. Suture Repair in Endoscopic Surgery for Craniovertebral Junction. Neurospine 2019; 16:257-266. [PMID: 31261465 PMCID: PMC6603818 DOI: 10.14245/ns.1938174.087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 06/12/2019] [Indexed: 11/25/2022] Open
Abstract
Objective Endoscopic approaches to the craniovertebral junction (CVJ) have been established as viable and effective surgical treatments in the past decade. One of the major complications is leakage of the cerebrospinal fluid (CSF). This study aimed to investigate the efficacy and feasibility of suture closure at the nasopharyngeal mucosa upon durotomy.
Methods A series of consecutive patients who underwent different endoscopic approaches to the CVJ were retrospectively reviewed. The pathologies, surgical corridors, neurological and functional outcomes, radiological evaluations, and complications were analyzed. Different strategies of repair for the intraoperative CSF leakage were described and compared.
Results A total of 22 patients covering 13 years were analyzed. There were 12, 2, and 8 patients who underwent transnasal, transoral, and combined approaches, respectively. There were 8 patients (36.4%) who experienced intraoperative CSF leakage, and were grouped into 2: 4 in the nonsuture (NS) group and 4 in the suture-repaired (SR) group. The NS group had 3 (75%) persistent CSF leakages postoperation that caused 1 mortality, whereas patients of the SR group had only 1 minor CSF rhinorrhea that healed spontaneously within days.
Conclusion In this series of 22 patients who required anterior endoscopic resection of pathologies at the CVJ, there was 1 (4.5%) serious complication related to CSF leakage. For patients who had no durotomy, the mucosal incision at the nasopharynx usually healed rapidly and there were few procedure-related complications. For patients with intraoperative CSF leakage, suture closure was technically challenging but could significantly lower the risks of postoperative complications.
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Affiliation(s)
- Mei-Yin Yeh
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wen-Cheng Huang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jau-Ching Wu
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chao-Hung Kuo
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Biomedical and Engineering, National Yang-Ming University, Taipei, Taiwan
| | - Hsuan-Kan Chang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tsung-Hsi Tu
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Taiwan International Graduate Program in Molecular Medicine, National Yang-Ming University and Academia Sinica, Taipei, Taiwan
| | - Peng-Yuan Chang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Tao-Yuan General Hospital, Ministry of Health and Welfare, Taoyuan City, Taiwan
| | - Yu-Shu Yen
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Henrich Cheng
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan
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Heinrich C, Gospodarev V, Kheradpour A, Zuppan C, Douglas CC, Minasian T. Benign Giant Cell Lesion of C1 Lateral Mass: A Case Report and Literature Review. Brain Sci 2019; 9:brainsci9050105. [PMID: 31071908 PMCID: PMC6562483 DOI: 10.3390/brainsci9050105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 05/06/2019] [Accepted: 05/07/2019] [Indexed: 02/02/2023] Open
Abstract
Primary osseous tumors of the spinal column account for approximately 1% of the total number of spinal tumors found in the pediatric patient population. The authors present a case of a C1 benign giant cell lesion that was incidentally found in a 15-year-old patient. A transoral biopsy was performed followed by treatment with denosumab, with definitive management in the form of transoral tumor resection with subsequent occiput-cervical three posterior instrumented fusion. The patient tolerated all of the procedures well, as there were no post-operative complications, discharged home neurologically intact and was eager to return to school when assessed during a follow-up visit in clinic. Osteolytic lesions affecting the cervical spine are rare in the pediatric population. It is of utmost importance to have sufficient background knowledge in order to formulate a differential diagnosis, as well as an understanding of principles underlying surgical techniques required to prevent occipital-cervical instability in this patient population. The information presented will guide surgical decision-making by identifying the patient population that would benefit from neurosurgical interventions to stabilize the atlantoaxial junction, in the context of rare osteolytic conditions affecting the cervical spine.
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Affiliation(s)
| | - Vadim Gospodarev
- Center for Perinatal Biology, Department of Basic Sciences, Loma Linda University, 11234 Anderson Street, Room 2567, Loma Linda, CA 92354, USA.
| | - Albert Kheradpour
- Department of Pediatric Hematology/Oncology, Loma Linda University Medical Center, 11234 Anderson Street, Loma Linda, CA 92354, USA.
| | - Craig Zuppan
- Department of Pathology, Loma Linda University Medical Center, 11234 Anderson Street, Loma Linda, CA 92354, USA.
| | - Clifford C Douglas
- Department of Neurosurgery, Loma Linda University Medical Center, 11234 Anderson Street, Room 2556, Loma Linda, CA 92354, USA.
| | - Tanya Minasian
- Department of Neurosurgery, Loma Linda University Medical Center, 11234 Anderson Street, Room 2556, Loma Linda, CA 92354, USA.
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36
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Abstract
Background : Transoral thyroid surgery represented by the da Vinci system is attracted attention and performed by several institutions. However, the current available da Vinci system still has some limitations to be improved for transoral thyroid surgery including high cost of equipment and expendables, larger diameter scope and instruments and no tactile sensation. It triggered us interest in more easily available robotic scope holder. Soloassist II (AktorMed GmbH, Barbing, Germany) is an active endoscope holder system which is controlled by a joystick. It has total six joints: three joints which are controlled by computer, one is controlled by manual and two act as a gimbal joint following the movement of the main body. Materials and Methods We tried transoral endoscopic thyroidectomy using Soloassist II (AktorMed GmbH, Barbing, Germany) in December 2017 in our hospital. Results We successfully performed four thyroid lobectomies in four patients with Soloassist II. We refined and described surgical procedures in each step using video clips. It provided an excellent vibration-free stable surgical view which enabled fatigue-free work, without shaking or tilting the horizon. The surgeon could perform transoral endoscopic thyroid surgery with only one assistant surgeon. Docking and preparation time for Soloassist was within 10 min in all four patients. The setup and dismantling could be performed parallel to the usual workflow. No complication was reported by any patient. Conclusions : The robotic scope holder (Soloassist II) seems to be safe and feasible equipment for performing transoral endoscopic thyroid surgery. Several possible advantages could be expected with this robotic scope holder.
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Affiliation(s)
- Jun-Ook Park
- Department of Otolaryngology Head and Neck Surgery, College of Medicine, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Mi Ra Kim
- Department of Otolaryngology Head and Neck Surgery, College of Medicine, Haeundae Paik Hospital, Inje University of Korea, Busan, South Korea
| | - Yeong Jun Park
- Department of Otolaryngology Head and Neck Surgery, College of Medicine, Haeundae Paik Hospital, Inje University of Korea, Busan, South Korea
| | - Min-Sik Kim
- Department of Otolaryngology Head and Neck Surgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Dong-Il Sun
- Department of Otolaryngology Head and Neck Surgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
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Abstract
INTRODUCTION With the cumulative increase in the number of patients undergoing bariatric surgery, postoperative weight regain has become a considerable challenge. Mechanisms for weight regain are not fully understood and the process is likely multifactorial in many cases. Endoluminal revisions that reduce gastric pouch size and diameter of the gastrojejunal anastomosis may offer an effective and less invasive management strategy for this population. AREAS COVERED We critically review data from case series, retrospective and prospective studies, and meta-analyses pertaining to weight regain after gastric bypass. A variety of endoscopic revision approaches are reviewed, including technique details, procedural safety and efficacy, and post-procedure care. EXPERT COMMENTARY Given the proliferation of endoluminal therapies with evidence showing safety and efficacy in the treatment of weight regain, it is likely that endoscopic revision will be the gold standard to treat weight regain in patients with gastric bypass.
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Affiliation(s)
- Diogo Turiani Hourneaux De Moura
- a Division of Gastroenterology, Hepatology and Endoscopy , Harvard Medical School, Brigham and Women's Hospital , Boston , MA , USA
| | - Christopher C Thompson
- a Division of Gastroenterology, Hepatology and Endoscopy , Harvard Medical School, Brigham and Women's Hospital , Boston , MA , USA
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38
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Kim WW, Lee J, Jung JH, Park HY, Tufano RP, Kim HY. A comparison study of the transoral and bilateral axillo-breast approaches in robotic thyroidectomy. J Surg Oncol 2018; 118:381-387. [PMID: 30182367 DOI: 10.1002/jso.25175] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 06/19/2018] [Indexed: 01/30/2023]
Abstract
OBJECTIVES Transoral robotic thyroidectomy (TORT) is a new remote access approach to avoid cervical incision. The purpose of this study is to compare two approaches used to avoid cervical incision: transoral approach and bilateral axillo-breast approach (BABA) in robotic thyroidectomy. METHODS A total of 90 patients were enrolled prospectively between September 2016 and April 2017. The BABA group had 43 and the TORT group had 47 patients, respectively. Parameters including clinicopathologic data, operative time, complications, laboratory data, hospital stay, postoperative pain, and cosmetic satisfaction were analyzed. RESULTS Complications were not different among the two groups. The operative time of TORT was longer than BABA until 15 cases of TORT were completed, but there was no difference after that. The Visual Analogue Scale score in TORT was lower than BABA in all the periods. TORT showed a higher cosmetic satisfaction after surgery. There was no infection or permanent mental nerve hypoesthesia in TORT. CONCLUSION Our study showed that TORT had less postoperative pain and a greater cosmetic satisfaction than the BABA. There were no significant differences in the postoperative surgical results between the two groups. TORT was comparable to the BABA in outcome with higher cosmetic satisfaction and less pain.
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Affiliation(s)
- Wan Wook Kim
- Department of Surgery, School of Medicine, Kyungpook National University, Daegu, South Korea
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jeeyeon Lee
- Department of Surgery, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Jin Hyang Jung
- Department of Surgery, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Ho Yong Park
- Department of Surgery, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Ralph P Tufano
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hoon Yub Kim
- Department of Surgery, KUMC Thyroid Center, Korea University Hospital, Korea University College of Medicine, Seoul, Korea
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Abstract
OBJECTIVE Transoral surgery is becoming a preferred technique because it does not leave any scar after surgery. However, transoral surgery for a dermoid cyst of the oral cavity is not standardized yet, due to the anatomic complexity of this region. The aim of this study was to evaluate the safety and efficacy of a transoral dermoid cyst excision. STUDY DESIGN Multicenter prospective observational study. SETTING University hospital. SUBJECTS AND METHODS This study was designed as a 4-year prospective multicenter evaluation of dermoid cyst excisions within the floor of mouth. Clinical outcomes and complications related to procedures were evaluated among patients. The primary outcome was the efficacy of the procedure, and the secondary outcome was cosmetic satisfaction of each procedure. RESULTS Twenty-one patients underwent transoral dermoid cyst excisions, and 22 underwent transcervical excisions. In the transoral surgery group, the mean size of the dermoid cyst was 5.35 cm (95% CI, 4.79-5.91), and in the transcervical surgery group, it was 6.19 cm (95% CI, 5.67-6.71). There was no significant differences with respect to overall demographic characteristics between the groups. However, the duration of the operation was shorter with the transoral group than with the transcervical group ( P = .001), and cosmetic satisfaction was much better in the transoral group ( P < .001). CONCLUSION Transoral dermoid cyst excision is a potentially safe and effective method that can lead to easy and quick removal of an oral cavity dermoid cyst, with excellent cosmetic outcomes.
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Affiliation(s)
- Jin Pyeong Kim
- 1 Department of Otolaryngology, Gyeongsang National University, Changwon, South Korea
- 2 Institute of Health Sciences, Gyeongsang National University, Jinju, South Korea
| | - Dong Kun Lee
- 3 Department of Otolaryngology-Head and Neck Surgery, Dong-A University College of Medicine, Busan, South Korea
| | - Jeong Hwan Moon
- 4 Department of Otorhinolaryngology, Dankook University College of Medicine, Cheonan, South Korea
| | - Jung Je Park
- 2 Institute of Health Sciences, Gyeongsang National University, Jinju, South Korea
- 5 Department of Otorhinolaryngology-Head and Neck Surgery, Gyeongsang National University, Jinju, South Korea
| | - Seung Hoon Woo
- 2 Institute of Health Sciences, Gyeongsang National University, Jinju, South Korea
- 5 Department of Otorhinolaryngology-Head and Neck Surgery, Gyeongsang National University, Jinju, South Korea
- 6 Beckman Laser Institute, University of California, Irvine, California, USA
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40
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Peng W, Peng XW, Li Z. [Application of transoral endoscopic thyroidectomy for benign thyroid nodule]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2018; 32:972-975. [PMID: 29986556 DOI: 10.13201/j.issn.1001-1781.2018.13.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Indexed: 11/12/2022]
Abstract
Objective:To evaluate the feasibility and application value of transoral endoscopic thyroidectomy for benign thyroid nodule.Method:Thirty-one patients with benign thyroid tumors underwent transoral endoscopic thyroidectomy via oral vestibular approach at our hospital between July 2016 and December 2017. Forty-five patients were enrolled as control group by conventional approach.Two groups were compared with regards to tumor size,types of operation, operation time, bleeding, volume of drainage, complication and postoperative hospital stay.Result:Pathology examinations proved benign in both groups.Two groups were matched by age, sex, tumor size and types of operation. No statistical significance was found in volume of drainage, postoperative hospital stay and complication. Endoscopic group:no permanent glottic paralysis;one patient had transient hoarseness and recovered after 3 months. In one case,subcutaneous seroma was noted.One patient suffered from cervical subcutaneous emphysema. One patient had a epidermal damage of the ala nasi on the side of the nasal intubation, and recovered after one week. no permanent glottic paralysis;One patient had transient hoarseness and recovered after 3 months. No local infection at the incision site or within the cervical spaces occurred. No mental nerve palsy was observed. Control group: one patients occurred transient hoarseness and recovered after 3 months. No permanent recurrent nerve paralysis occurred; one patient suffered from local infection; one patient had subcutaneous seroma; one cases of postoperative hematoma occurred after 8 hours later. The average blood loss of endoscopic surgery was (20±4) ml, and the mean of operation time was (107±11) min. The difference was statistically significant between the endoscopic surgery and the conventional surgery.Conclusion:The novel transoral endoscopic thyroidectomy is feasible and safe,and it may be a good choice for patients with beauty needs.
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Affiliation(s)
- W Peng
- Department of Oncology Plastic Surgery/ Head and Neck Surgery, Hunan Cancer Hospital, the Affiliated Tumor Hospital of Xiangya Medical School, Central South University, Changsha,410006,China
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Tay G, Tan HK, Nguyen TK, Phee SJ, Iyer NG. Use of the EndoMaster robot-assisted surgical system in transoral robotic surgery: A cadaveric study. Int J Med Robot 2018; 14:e1930. [PMID: 29869407 DOI: 10.1002/rcs.1930] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 05/13/2018] [Accepted: 05/13/2018] [Indexed: 11/12/2022]
Abstract
BACKGROUND The EndoMaster is a novel robot-assisted surgical system originally designed for endoscopic resection of gastrointestinal polyps and tumours. It incorporates two robotic arms (a grasper and a probe for monopolar diathermy) into the end of a flexible endoscope, creating improved manoeuvrability, with two arms allowing for 9 degrees of movement and triangulation; this enables fine manipulation and dissection of tissues. METHODS The EndoMaster was used in two human cadavers to perform 4 radical tonsillectomies to evaluate its performance in transoral robotic surgery (TORS). RESULTS The EndoMaster allowed for good visualization of the surgical field and its compact form factor allowed for quick docking and avoided the problem of clashing of the working arms. CONCLUSION The EndoMaster system shows promising potential for use in TORS. Further refinements to movements of the effector arms are required.
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Affiliation(s)
- Gerald Tay
- Singhealth Duke-NUS Head and Neck Centre, Singapore
| | | | | | - Soo Jay Phee
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore
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Patwa HS, Yanez-Siller JC, Gomez Galarce M, Otto BA, Prevedello DM, Carrau RL. Analysis of the far-medial transoral endoscopic approach to the infratemporal fossa. Laryngoscope 2018; 128:2273-2281. [PMID: 29729008 DOI: 10.1002/lary.27223] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 02/28/2018] [Accepted: 03/14/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS To demonstrate anatomic relationships of the far-medial transoral endoscopic assisted approach (FMT-EAA) to the infratemporal fossa (ITF) and define the corridor dimensions, surgical freedom, and limitations associated with this approach. STUDY DESIGN Cadaveric study. METHODS Twenty ITFs (10 specimens) were dissected with the assistance of 0 °, 30 °, and 45 ° rod-lens endoscopes. Image guidance was used to confirm and measure the corridors' structural boundaries and document the anatomical relationships encountered in this approach. RESULTS Access to the ITF via the FMT-EAA can be divided into two secondary surgical corridors: the superomedial and inferolateral triangles, each of which provides access to different areas. The superomedial triangle is bounded medially by the lateral pterygoid plate and posterolateral maxillary sinus wall, superiorly by the greater sphenoid wing, and inferolaterally by the lateral pterygoid muscle. The inferolateral triangle is bounded superiorly by the lower head of the lateral pterygoid muscle, inferiorly by the medial pterygoid muscle, and laterally by the mandible. Using a standard 19-mm endoscope, the FMT-EAA achieves a mean surgical freedom of 231 mm and 161 mm in the vertical and horizontal planes, respectively. CONCLUSIONS FMT-EAA adequately exposes critical structures of the ITF. This technique is a viable option for the management of selected ITF lesions, either alone or in combination with alternative minimally invasive approaches to the region. LEVEL OF EVIDENCE NA Laryngoscope, 128:2273-2281, 2018.
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Affiliation(s)
- Hafiz S Patwa
- Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, Wake Forest Baptist Medical Center, Winston Salem, North Carolina, U.S.A
| | - Juan C Yanez-Siller
- Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, U.S.A
| | - Matias Gomez Galarce
- Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, U.S.A.,Department of Otolaryngology, German Hospital of Santiago, Santiago, Chile
| | - Bradley A Otto
- Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, U.S.A.,Department of Neurosurgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, U.S.A
| | - Daniel M Prevedello
- Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, U.S.A.,Department of Neurosurgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, U.S.A
| | - Ricardo L Carrau
- Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, U.S.A.,Department of Neurosurgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, U.S.A
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Ong HS, Gokavarapu S, Tian Z, Li J, Cao W, Zhang CP. Does a mandibular access osteotomy improve survival in pT2 oral tongue cancers? Retrospective study at a single institution. Int J Oral Maxillofac Surg 2018; 47:289-295. [PMID: 28927743 DOI: 10.1016/j.ijom.2017.08.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 04/24/2017] [Accepted: 08/29/2017] [Indexed: 02/07/2023]
Abstract
The surgical approach to the resection of oral tongue cancers can involve transoral resection (TOR) or a temporary mandibulotomy access (TMA). There are no relevant guidelines, and the oncological safety of TOR needs consideration. The objective of this study was to investigate TMA and TOR in pT2 oral tongue cancer surgery with regard to cancer outcomes. Demographic, surgical, and histology data from primary pT2 tongue cancers were recorded and evaluated through multivariate Cox regression for local recurrence (LR), disease-free survival (DFS), and overall survival (OS). A total of 166 patients with pT2 primary oral tongue cancer fulfilled the inclusion criteria; TOR was used in 95 patients and TMA in 71 patients. The minimum follow-up was 29 months. Group comparisons showed a significantly higher frequency of perineural spread (P=0.013) in the TMA group; a higher frequency of involved margins on initial resection was seen in TOR patients (P=0.010). Adjuvant postoperative radiotherapy was preferred in the TMA group, in line with the high pN positive status. Multivariate Cox regression showed significantly higher LR and lower DFS in the TOR group despite stratification of the major prognostic factors. The 5-year survival rate was reduced to 82.2% in the TOR group, while it remained constant at 93.0% in the TMA group. TMA provided superior local control and DFS compared to TOR in pT2 tongue cancers.
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Affiliation(s)
- H S Ong
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - S Gokavarapu
- Head and Neck Oncology Reconstructive Surgery, Department of Surgical Oncology, Krishna Institute of Medical Science, Hyderabad, Telangana, India
| | - Z Tian
- Department of Oral Pathology, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - J Li
- Department of Oral Pathology, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - W Cao
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - C P Zhang
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Keskil S, Göksel M, Yüksel U. Transoral screw and wire fixation for unstable anterior ½ atlas fracture. J Craniovertebr Junction Spine 2018; 8:364-368. [PMID: 29403251 PMCID: PMC5763596 DOI: 10.4103/jcvjs.jcvjs_94_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Study Design: Atlas fractures are evaluated according to the fracture type and ligamentous injury. External immobilization may result in fracture nonunion. Objective: The ideal treatment method for non-stabilized atlas fractures is limited fixation without restricting the range of motion of the atlantoaxial and atlantooccipital joints. Summary of Background Data: Such a result can be established by using either anterior fixation or posterior lateral mass fixation. However, none of these techniques can fully address anterior 1/2 atlas fractures such as in this case. Materials and Methods: A transoral technique in which bilateral screws were placed intralaminarly and connected with wire was used to reduce and stabilize an anterior 1/2 fracture of C1. Result: Radiological studies after the surgery showed good cervical alignment, no screw or wire failure and good reduction with fusion of anterior arcus of C1. Conclusions: Internal immobilization by this screw and wire osteosynthesis technique protects the mobility of the atlanto-occipital and atlantoaxial joints. The main advantage is that neither the twisted wires inserted under the anterior lamina, nor the laterally placed screw heads interfere with midline wound closure; unlike the plate/cage and rod systems used together with anterior screws. A computer navigation system with intraoperative 3D imaging facilities will be of benefit for safe placement of the screw, however we preferred a free-hand technique, as the starting point was at the fracture line along the trajectory of the routinely accessible anterior lamina.
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Affiliation(s)
- Semih Keskil
- Department of Neurosurgery, Kırıkkale University Medical School, Kırıkkale, Turkey
| | - Murat Göksel
- Department of Neurosurgery, Kırıkkale University Medical School, Kırıkkale, Turkey
| | - Ulas Yüksel
- Department of Neurosurgery, Kırıkkale University Medical School, Kırıkkale, Turkey
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45
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Kahramangil B, Mohsin K, Alzahrani H, Bu Ali D, Tausif S, Kang SW, Kandil E, Berber E. Robotic and endoscopic transoral thyroidectomy: feasibility and description of the technique in the cadaveric model. Gland Surg 2018; 6:611-619. [PMID: 29302476 DOI: 10.21037/gs.2017.10.03] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Numerous new approaches have been described over the years to improve the cosmetic outcomes of thyroid surgery. Transoral approach is a new technique that aims to achieve superior cosmetic outcomes by concealing the incision in the oral cavity. Methods Transoral thyroidectomy through vestibular approach was performed in two institutions on cadaveric models. Procedure was performed endoscopically in one institution, while the robotic technique was utilized at the other. Results Transoral thyroidectomy was successfully performed at both institutions with robotic and endoscopic techniques. All vital structures were identified and preserved. Conclusions Transoral thyroidectomy has been performed in animal and cadaveric models, as well as in some clinical studies. Our initial experience indicates the feasibility of this approach. More clinical studies are required to elucidate its full utility.
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Affiliation(s)
- Bora Kahramangil
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Khuzema Mohsin
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Hassan Alzahrani
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Daniah Bu Ali
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Syed Tausif
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Sang-Wook Kang
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Emad Kandil
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Eren Berber
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH, USA
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Rama-López J, Tomás-Fernandez M, García-Garza C, Martínez-Madrigal M. Pharyngeal perforation after anterior cervical spine surgery treated by transoral endoscopic surgery. Head Neck 2017; 40:E13-E16. [PMID: 29206327 DOI: 10.1002/hed.25030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 10/01/2017] [Accepted: 10/25/2017] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Anterior cervical fixation has been used since 1967 for multiple pathologies like traumatism, compressive myelopathy, or spinal infections. METHODS We report the case of a patient who had undergone cervical spine surgery 10 years previously and presented to our clinic with a pharyngeal fistula due to surgical screw displacement that was treated by transoral endoscopic surgery. RESULTS The immediate postoperative period occurred without incidence and complete odynophagia resolution. The patient was discharged home the fourth day after surgery. Follow-up after 1 year showed no evidence of spinal fixation hardware mobilization. CONCLUSION We consider the transoral endoscopic approach a feasible low comorbidity technique to treat anterior cervical plate mobilization with pharyngeal and pharyngoesophageal perforations.
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Affiliation(s)
- Julio Rama-López
- Ear, Nose, and Throat Department, University Hospital Son Espases, Palma Mallorca, Spain
| | | | - César García-Garza
- Ear, Nose, and Throat Department, University Hospital Son Espases, Palma Mallorca, Spain
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Abstract
Gastroesophageal reflux disease (GERD) is a common condition that places a significant burden on the healthcare system. Additionally, there have been concerns raised about potential risks of long-term proton pump inhibitors. Laparoscopic anti-reflux surgery is currently the gold standard option for patients when surgery is planned. However, there continues to be interest in an endoscopic, alternative to laparoscopic surgery. Transoral incisionless fundoplication (TIF) is being increasingly utilized for such patients. We review the indications, patient selection and technique for this procedure. A video of the procedure, which we previously published on CTSNet is also attached.
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Affiliation(s)
- Hiran C Fernando
- Inova Schar Cancer Institute, Inova Fairfax Medical Campus, Falls Church, Virginia, VA, USA
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Yu WH, Chen K, Pan Y, Zhu HP, Gao JQ, Pan JH, Zheng XY, Wang XF. Intracorporeal esophagojejunostomy using the transorally inserted anvil (OrVil) after laparoscopic total gastrectomy for upper gastric cancer. Int J Clin Exp Pathol 2017; 10:9704-9709. [PMID: 31966852 PMCID: PMC6965961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 08/01/2017] [Indexed: 06/10/2023]
Abstract
BACKGROUND Totally laparoscopic distal gastrectomy gained wide popularity in recent years. Laparoscopic total gastrectomy with intracorporeal esophagojejunostomy (LTGIE) is much less performed. In this study, we reported our preliminary experience of LTGIE using the transorally inserted anvil (OrVil). METHODS Clinical data of patients with upper gastric cancer who underwent LTGIE from January 2016 to January 2017 were retrospectively collected. The operative time, intraoperative blood loss, postoperative recovery time of intestinal function, the length of hospitalization and postoperative complications were summarized and compared between early and later cases. RESULTS There were totally 26 patients underwent LTGIE using OrVil successfully. The mean total operation time and esophagojejunostomy time was 272.8 min and 45.3 min. The mean estimated blood loss was 113.8 ml. The mean first flatus time was 3.1±0.9 days and the postoperative length of hospitalization (LOH) was 13.0±6.4 days. Three patients suffered postoperative complications, including one abdominal fluid collection, one pulmonary embolism and one pulmonary infection. During the follow-up period, neither local recurrence nor anastomosis-related morbidity was observed. CONCLUSIONS The LTGIE using OrVil is feasible and safe for upper gastric cancer. These preliminary results warrant further evaluation in a larger population to validate.
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Affiliation(s)
- Wei-Hua Yu
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University Hangzhou, China
| | - Ke Chen
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University Hangzhou, China
| | - Yu Pan
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University Hangzhou, China
| | - He-Pan Zhu
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University Hangzhou, China
| | - Jia-Qi Gao
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University Hangzhou, China
| | - Jun-Hai Pan
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University Hangzhou, China
| | - Xue-Yong Zheng
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University Hangzhou, China
| | - Xian-Fa Wang
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University Hangzhou, China
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Abstract
Remote-access approaches to the thyroid gland have seen a rapid evolution recently with the development of various techniques to minimize the cosmetic and quality-of-life impact of a visible scar. Most approaches have required significantly more tissue dissection and have been limited in their extent to treat contralateral disease. The transoral approach is the most recent iteration of "scarless" thyroidectomy and offers various advantages over other techniques including less tissue dissection, equal access to both sides of the neck, and a superb midline view of the anatomy. Transoral thyroidectomy may be performed with either laparoscopic or robotic technology, each with various advantages and disadvantages. Herein, we discuss our experience with transoral robotic thyroidectomy (TORT).
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Affiliation(s)
- Jeremy D Richmon
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Hoon Yub Kim
- Department of Surgery, Korea University Thyroid Center, Korea University College of Medicine, Seoul, South Korea
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50
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Abstract
Recently, natural orifice transluminal endoscopic surgery (NOTES) has been applied in thyroid surgery with transoral access. The benefit of transoral endoscopic thyroidectomy is the potential for scar-free surgery. However, there are many concerns over some aspects, such as infection, recurrent laryngeal nerve injury, and oncological outcome. In this paper, we have reviewed the development history and the current clinical evidence of this innovative surgery. We conclude that the transoral endoscopic thyroidectomy vestibular approach (TOETVA) is feasible and can be considered no longer an experimental operation.
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Affiliation(s)
- Angkoon Anuwong
- Department of Surgery, Minimally Invasive and Endocrine Surgery Division, Police General Hospital, Bangkok, Thailand
| | - Hoon Yub Kim
- Department of Surgery, KUMC Thyroid Center, Korea University College of Medicine, Seoul, Korea
| | - Gianlorenzo Dionigi
- Department of Surgical Sciences and Human Morphology, 1st Division of Surgery, Research Center for Endocrine Surgery, University of Insubria (Como-Varese), Varese, Italy
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