Salvage Transoral Robotic Surgery: A Case of a Nearly Missed Carotid Injury.
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ABSTRACT:
SUBMITTER: Turner MT
PROVIDER: S-EPMC7470716 | biostudies-literature | 2021 Jan
REPOSITORIES: biostudies-literature
Publications
Salvage Transoral Robotic Surgery: A Case of a Nearly Missed Carotid Injury.
Turner Meghan T MT Persky Michael J MJ Moskovitz Jessica M JM Kim Seungwon S
Ear, nose, & throat journal 20190923 1
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Project description:Transoral robotic surgery (TORS) has emerged as a technique that allows head and neck surgeons to safely resect large and complex oropharyngeal tumors without dividing the mandible or performing a lip-split incision. These resections provide a reconstructive challenge because the cylinder of the oropharynx remains closed and both physical access and visualization of oropharyngeal anatomy is severely restricted. Transoral robotic reconstruction (TORRS) of such defects allows the reconstructive surgeon to inset free flaps or perform adjacent tissue transfer while seeing what the resecting surgeon sees. Early experience with this technique has proved feasible and effective. Robotic reconstruction has many distinct advantages over conventional surgery, and offers patients a less morbid surgical course. In this review, we discuss the clinical applicability of transoral robotic surgery in head and neck reconstruction, highlighting the benefits and limitations of such an approach, and outlining the guidelines for its utilization.
| S-EPMC3948381 | biostudies-other
Project description:BACKGROUND:To report our experience of postoperative haemorrhage in patients following transoral robotic surgery (TORS). METHODS:Data were collected on patients having TORS. Postoperative haemorrhage within 30 days was graded using the Mayo Clinic grading system. RESULTS:Transoral robotic surgery operations were performed on 122 patients. There were 23 bleeding events classified as minor to severe following 19 operations (16%). Haemorrhage requiring a return to the operating room occurred after 7 operations (6%). The odds of an emergent haemorrhage were 5.19 times greater in patients who had a staged neck dissection after TORS (P = .05). The odds of a postoperative bleeding event were 2.6 times greater in patients receiving a larger resection (P = .107). There were no haemorrhage events in the 36 patients who received a synchronous neck dissection with transcervical ligation of the external carotid artery. CONCLUSIONS:Surgical intervention for TORS haemorrhage occurred in 6% patients. No haemorrhage occurred in patients who had ligation of the external carotid artery.
| S-EPMC5851834 | biostudies-literature
Project description:ObjectiveThis study describes the potential application of intraoperative ultrasound imaging during transoral robotic surgery (TORS).MethodsUltrasound imaging was performed during transoral robotic resection of oropharyngeal tumors in 10 patients at a tertiary academic center. Ultrasound imaging was utilized to identify large-caliber vessels adjacent to the surgical site. Measurements were also taken on the ultrasound of tumor thickness to determine the deep margin. Following resection, the tumor was sectioned, and a gross measurement of the tumor thickness was obtained.ResultsIntraoperative ultrasound use led to the identification of larger-caliber blood vessels within the operative field prior to encountering them visually. Ultrasound could also aid in defining deep tumor margins; the tumor thickness measured via ultrasound was found to be accurate within 1 to 2 mm of the grossly measured tumor thickness. This allowed for focused, careful dissection to protect and avoid blood vessels during dissection as well as improved tumor resection.ConclusionsThe use of intraoperative ultrasound provides additional information to the head and neck surgeon during TORS. This may be used to identify blood vessels and assess tumor margins, thereby improving the safety and efficacy of TORS.
| S-EPMC5458621 | biostudies-literature
Project description:This article outlines the ways that transoral robotic surgery and transoral laser microsurgery relate to treatment de-escalation in the treatment of head and neck cancer. Treatment de-escalation has particular importance in context of human papillomavirus-related oropharynx squamous cell carcinoma, which responds well to therapy but leaves many survivors with decades of treatment-related sequelae. We compare these less invasive transoral approaches with previously used open approaches to the oropharynx. We discuss the topic of treatment de-escalation in human papillomavirus-related disease and outline completed and ongoing clinical trials investigating the choice of primary treatment modality and de-escalation of adjuvant therapy.
| S-EPMC8060871 | biostudies-literature
Project description:Due to significant differences in healthcare structure between the United States and Canada, there are unique barriers to adopting new medical technology in Canada. In this article, we describe our experience developing a transoral robotic surgery (TORS) program at Western University. Specifically, we outline the steps that were necessary to obtain institutional and multidisciplinary team approval, financial support, as well as surgeon and allied healthcare personnel training. This experience can potentially be used as a roadmap for other Canadian institutions pursuing a TORS program.
| S-EPMC3650936 | biostudies-other
Project description:ImportanceLarge patient cohorts are necessary to validate the efficacy of transoral robotic surgery (TORS) in the management of head and neck cancer.ObjectivesTo review oncologic outcomes of TORS from a large multi-institutional collaboration and to identify predictors of disease recurrence and disease-specific mortality.Design, setting, and participantsA retrospective review of records from 410 patients undergoing TORS for laryngeal and pharyngeal cancers from January 1, 2007, through December 31, 2012, was performed. Pertinent data were obtained from 11 participating medical institutions.InterventionsSelect patients received radiation therapy and/or chemotherapy before or after TORS.Main outcomes and measuresLocoregional control, disease-specific survival, and overall survival were calculated. We used Kaplan-Meier survival analysis with log-rank testing to evaluate individual variable association with these outcomes, followed by multivariate analysis with Cox proportional hazards regression modeling to identify independent predictors.ResultsOf the 410 patients treated with TORS in this study, 364 (88.8%) had oropharyngeal cancer. Of these 364 patients, information about post-operative adjuvant therapy was known about 338: 106 (31.3) received radiation therapy alone, and 72 (21.3%) received radiation therapy with concurrent chemotherapy. Neck dissection was performed in 323 patients (78.8%). Mean follow-up time was 20 months. Local, regional, and distant recurrence occurred in 18 (4.4%), 15 (3.7%), and 10 (2.4%) of 410 patients, respectively. Seventeen (4.1%) died of disease, and 13 (3.2%) died of other causes. The 2-year locoregional control rate was 91.8% (95% CI, 87.6%-94.7%), disease-specific survival 94.5% (95% CI, 90.6%-96.8%), and overall survival 91% (95% CI, 86.5%-94.0%). Multivariate analysis identified improved survival among women (P = .05) and for patients with tumors arising in tonsil (P = .01). Smoking was associated with worse overall all-cause mortality (P = .01). Although advanced age and tobacco use were associated with locoregional recurrence and disease-specific survival, they, as well as tumor stage and other adverse histopathologic features, did not remain significant on multivariate analysis.Conclusions and relevanceThis large, multi-institutional study supports the role of TORS within the multidisciplinary treatment paradigm for the treatment of head and neck cancer, especially for patients with oropharyngeal cancer. Favorable oncologic outcomes have been found across institutions. Ongoing comparative clinical trials funded by the National Cancer Institute will further evaluate the role of robotic surgery for patients with head and neck cancers.
| S-EPMC5019351 | biostudies-literature
Project description:ObjectiveWe analyzed the outcomes for patients with a retropharyngeal internal carotid artery (ICA) who underwent a transoral robotic surgery (TORS) procedure involving a cervical-transoral robotic oropharyngectomy course with free flap reconstruction.MethodsPatients were included in the prospective multicentric trial NCT02517125. These patients were scheduled to undergo surgery for an oropharyngeal localization. By pre-operative CT scan and MRI it was determined that they had a retropharyngeal internal carotid artery.ResultsThree patients had a retropharyngeal ICA: a patient with a 35 mm synovial sarcoma of the tonsillar fossa, a patient with a T2N2b squamous-cell carcinoma (SCC) of the glossotonsillar sulcus, and a patient with a T3N0 SCC of the tonsillar fossa in a previously irradiated field. These patients encountered neither preoperative nor postoperative complications.ConclusionsIn our experience, TORS for oropharyngeal cancers appears to be feasible in patients with a retropharyngeal ICA, provided that the procedure has been adapted for complex situations.Level of evidence4.
| S-EPMC5915826 | biostudies-literature
Project description:ObjectivesTo compare taste changes after transoral robotic surgery (TORS) to taste changes in healthy controls.MethodsOropharyngeal cancer patients receiving TORS and healthy controls were recruited. Participants underwent posterolateral and whole-mouth psychophysical taste testing (identification, intensity, and hedonics) at baseline and at 2 weeks postoperatively (patients) or follow-up (controls). Surgeons reported suspension time and glossopharyngeal nerve injury (GNI) based on the identification and sacrifice of the nerve. A Clinical Global Impression (CGI) of taste symptoms was completed at each session ("My sense of taste bothers me" on a 5-point scale from Never [1] to Always [5]). A taste disorder (TD) was a CGI of 3 (Sometimes) or worse. Within-subject changes in CGI and psychophysical scores were computed. "Worsened taste" was a CGI increase by ≥1 point at follow-up.ResultsOf 69 participants, most (33/37 tumor, 31/32 controls) had normal baseline taste (CGI < 3). 14/33 (42%) TORS patients and no controls developed new TDs at follow-up. More smokers (7/9) had worsened taste than nonsmokers (19/60, difference = 46% [95% CI 16%-76%]). More patients without GNI (6/22) than with GNI (0/15) had postoperative phantogeusia (difference = 27% [95% CI 9-45%]). Tumor-ipsilateral taste identification (TI) decreased more in patients (-11.3%) than controls (0.8%, difference = 12.2% [95% CI 5.0-19.3%]). Suspension time was not associated with worsened taste symptoms or psychophysical changes.ConclusionsPatient-reported taste changes after TORS are frequent. Compared to healthy controls, TORS patients have decreased tumor-ipsilateral TI. Suspension time and GNI are unlikely to cause symptomatic TDs. Further investigations of the etiology and long-term symptom burden of TORS-associated TDs will aid in the management of oropharyngeal cancer patients.Level of evidence3 (non-randomized controlled cohort study) Laryngoscope, 133:3520-3528, 2023.
| S-EPMC10843268 | biostudies-literature
Project description: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 methodsWe tried transoral endoscopic thyroidectomy using Soloassist II (AktorMed GmbH, Barbing, Germany) in December 2017 in our hospital.ResultsWe 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.
| S-EPMC7440021 | biostudies-literature
Project description:ObjectiveTo evaluate the cost-effectiveness of transoral robotic surgery (TORS) for the diagnosis and treatment of cervical unknown primary squamous cell carcinoma (CUP).Study designCase series with chart review.SettingTertiary academic hospital.Subjects and methodsA retrospective chart review was performed on patients with new occult primary squamous cell carcinoma of the head and neck with nondiagnostic imaging and/or endoscopy who were treated with TORS at a tertiary hospital between 2009 and 2012. Direct costs were obtained from the hospital's billing system, and national data were used for inpatient hospital costs and physician fees. The proportion of tumors found in 3 strategies was used as effectiveness to calculate the incremental cost-effectiveness ratio.ResultsIn total, 206 head and neck robotic cases were performed at our institution between December 2009 and December 2012. Three surgeons performed TORS on 22 patients for occult primary squamous cell carcinoma. The primary tumor was located in 19 of 22 patients (86.4%). The incremental cost-effectiveness ratio for sequential and simultaneous examination under anesthesia with tonsillectomy (EUA) and TORS base of tongue resection was $8619 and $5774 per additional primary identified, respectively.ConclusionSequential EUA followed by TORS is associated with an incremental cost-effectiveness ratio of $8619 compared with traditional EUA alone. Bilateral base of tongue resection should be considered in the workup of these patients, particularly if the palatine tonsils have already been removed.
| S-EPMC4167971 | biostudies-literature