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Transoral robotic surgery

Nir Hirshoren, Olivia Ruskin, Tsien Fua, Stephen Kleid, Matthew Magarey, Benjamin Dixon
BACKGROUND: Transoral robotic surgery (TORS) is now a well-validated technique for resection of head and neck cancers. Benefits include reduced patient morbidity, swallowing preservation and rationalization of adjuvant therapies. METHODS: This was a single-centre, retrospective review of 35 patients who underwent TORS of oro-, retro- and parapharyngeal tumours between March 2014 and August 2015. Outcome measures included resection margins, swallowing function and impact on post-operative radiotherapy...
October 21, 2016: ANZ Journal of Surgery
David Hamilton, Vinidh Paleri
Morbidity and mortality associated with increasingly radical doses of chemoradiotherapy have led many to question the current standard of care in head and neck cancer. Recently, surgeons have developed minimally invasive, transoral techniques which have demonstrated excellent survival and favourable functional outcomes. Transoral robotic surgery (TORS) is the most recent, cutting edge in the evolution of transoral techniques; TORS allows surgeons unprecedented access to and visualisation of the upper aerodigestive tract...
October 11, 2016: Surgeon: Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland
Mark A D'Agostino
The standard treatment for patients with obstructive sleep apnea syndrome is positive airway pressure (PAP) therapy. However when PAP therapy fails, surgery maybe an option to alleviate the obstruction. The base of tongue plays an important role in this obstruction, and addressing the tongue base surgically can be a challenge for the head and neck surgeon. Transoral robotic surgery (TORS) using the da Vinci Surgical System provides a safe and effective way to approach and manage the base of tongue and supraglottis...
October 11, 2016: Otolaryngologic Clinics of North America
Arzu-Karaman Koç, Yakup Yegin, Mustafa Çelik, Mehmet Sar, Damlanur Sakiz, Fatma-Tülin Kayhan
INTRODUCTION: Sialadenoma papilliferum (SP) is a rare benign tumor, which originates from the minor salivary gland. It occurs at sites that have minor salivary glands, such as the palate, retromolar pads, buccal mucosa, and lips. The most common location for tumor development is on the hard palate. A differential diagnosis consists of ruling out other salivary gland tumors. Transoral robotic surgery (TORS) is a new technology used in head and neck surgery within certain centers around the world...
September 2016: Iranian Journal of Otorhinolaryngology
S Lang, S Mattheis, B Kansy
In this chapter, we discuss implications of tumor site and tumor microenvironment properties of human papilloma virus (HPV)-associated cancer formation with special emphasis on the therapeutic modality of transoral robotic surgery (TORS). Over the past years, the development of robotic systems has improved, and therefore, its use in the surgical treatment of HNSCC has become a relevant treatment modality for many patients. Yet, there are limitations. Especially for endolaryngeal TORS procedures, additional technical development is mandatory, particularly with respect to visualization and manipulation...
2017: Recent Results in Cancer Research
D C Ling, B V Chapman, J Kim, G W Choby, P Kabolizadeh, D A Clump, R L Ferris, S Kim, S Beriwal, D E Heron, U Duvvuri
OBJECTIVE: It has been postulated that treatment outcomes are similar between transoral robotic surgery (TORS) and definitive chemoradiation (CRT) for oropharyngeal squamous cell carcinomas (OPSCC). We compared oncologic and quality of life (QOL) outcomes between definitive CRT and definitive TORS. MATERIALS AND METHODS: An observational comparison study was performed on 92 patients treated with TORS±adjuvant therapy and 46 patients treated with definitive CRT between July 2005 and January 2016...
October 2016: Oral Oncology
J Lam, G Scott, D A Palma, K Fung, A V Louie
No abstract text is available yet for this article.
October 1, 2016: International Journal of Radiation Oncology, Biology, Physics
W Chen, F L Xu, Y Chen, Y Zhang, K M Wu, Y Cheng, J F Ji, H L Zheng
Objective: To summarize clinical experience on application of transoral robotic surgery (TORS) in pharyngeal tumour resection. Methods: Six patients underwent TORS with da Vinci(®) surgical system in our department from November 2013 to July 2015 and their clinical data were analyzed retrospectively. Results: TORS was accomplished successfully in all 6 patients. The surgical field-exposed time ranged from 30 to 40 minutes with an average of 35 minutes. The operative time ranged from 30 to 130 minutes with an average of 72 minutes...
September 7, 2016: Zhonghua Er Bi Yan Hou Tou Jing Wai Ke za Zhi, Chinese Journal of Otorhinolaryngology Head and Neck Surgery
Emily Cox, Ahmad Ghasemloonia, Steven C Nakoneshny, Kourosh Zareinia, Mark Hudon, John T Lysack, Garnette R Sutherland, Joseph C Dort
The majority of head and neck cancers arise from the oral cavity and oropharynx. Many of these lesions will be amenable to surgical resection using transoral approaches including transoral robotic surgery (TORS). To develop and control TORS tools, precise dimensions of the oral cavity and pharynx are desirable. CT angiograms of 76 patients were analyzed. For the oral cavity, only the maximum length and width were measured, while for the pharynx, the width, length, and areas of the airway were all measured and the volume calculated...
September 23, 2016: Journal of Robotic Surgery
Da Hee Kim, Hwan Kim, Sanghyun Kwak, Kwangha Baek, Gina Na, Ji Hoon Kim, Se Heon Kim
The da Vinci system (da Vinci Surgical System; Intuitive Surgical Inc.) has rapidly developed in several years from the S system to the Si system and now the Xi System. To investigate the surgical feasibility and to provide workflow guidance for the newly released system, we used the new da Vinci Xi system for transoral robotic surgery (TORS) on a cadaveric specimen. Bilateral supraglottic partial laryngectomy, hypopharyngectomy, lateral oropharyngectomy, and base of the tongue resection were serially performed in search of the optimal procedures with the new system...
October 2016: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques
Sabapathy Giridhar Suren Krishnan, Kandiah Umapathysivam, Craig Lockwood, John-Charles Hodge
The objective of this systematic review is to synthesize the best available evidence regarding the oncological and survival outcomes (as measured by disease control, disease-free survival, disease-specific survival and overall survival) of transoral robotic surgery (TORS) versus transoral laser microsurgery (TLM) in the treatment of oropharyngeal squamous cell carcinoma in adults (aged 18 years or older). Specifically the review questions are:1 Is there a difference in oncological outcomes between a traditional "Halstedian" en bloc tumor resection technique used in TORS versus a modern segmental tumor dissection technique used in TLM?2 Does one surgical approach confer better oncological outcomes with respect to a particular patient subgroup, such as patients with a positive human papilloma virus status or patient's with different tumor T-stages?...
August 2016: JBI Database of Systematic Reviews and Implementation Reports
Steven Dirven, Jacqueline Allen
PURPOSE OF REVIEW: Investigation and surgical manipulation of the larynx, pharynx, and oesophagus suffer from inherent challenges with access to the sites of interest. To reduce trauma and external scarring, visualization and minimally invasive interventions by the transnasal or transoral routes have become more prevalent. This article discusses engineering methods used to understand and overcome the mechanical constraints inside the airway and upper gastrointestinal tract, and examines the role that robotics and engineering are beginning to play in modelling of surgical interventions in this region...
August 31, 2016: Current Opinion in Otolaryngology & Head and Neck Surgery
Filippo Montevecchi, Chiara Bellini, Giuseppe Meccariello, Paul T Hoff, Elisa Dinelli, Iacopo Dallan, Ruggero M Corso, Claudio Vicini
Pediatric obstructive sleep apnea syndrome (OSAS) is primarily caused by adenotonsillar hypertrophy. However, tongue base hypertrophy is increasingly being recognized as a cause, even after adenotonsillectomy. We report three cases of pediatric OSAS successfully treated by transoral robotic reduction of the tongue base. In all children, we were able to achieve improved retrolingual patency while avoiding significant procedure-related morbidity. In conclusion, tongue base reduction by transoral robotic surgery appears to be a feasible solution for the base of tongue obstruction due to lingual tonsil hypertrophy in pediatric patients...
August 27, 2016: European Archives of Oto-rhino-laryngology
Jose Granell, Ana Alonso, Laura Garrido, Raimundo Gutierrez-Fonseca
Soft tissue robotics found its trigger for success in minimally invasive surgery. The minimization of the surgical damage is more obvious as the surgical alternative is more aggressive. In head and neck surgery, potential sequelae are both functional and cosmetic. Robotic instrumentation might allow for further development of the transoral approach to the deep regions of the face.The authors present an uneventful, fully robotic, transoral surgical excision of a parapharyngeal hemangioma. The authors discuss management alternatives, surgical risks, and safety measures...
October 2016: Journal of Craniofacial Surgery
Sarah Owen, Mark Puvanendran, David Meikle, Isobel Bowe, James O'Hara, Joanne Patterson, Vinidh Paleri
OBJECTIVES: To explore whether pre-treatment swallowing measures predict swallowing recovery at 6 weeks after transoral robotic surgery. DESIGN: Prospective cohort study. SETTING: Tertiary care cancer centre in the United Kingdom. PARTICIPANTS: 51 consecutive patients undergoing transoral robotic surgery for head and neck cancer, between April 2013 and February 2015. MAIN OUTCOME MEASURES: Swallowing function assessed by Performance Status Scale (PSS) Normalcy of Diet, timed water swallow test capacity scores (WST), and duration of tube feeding...
August 20, 2016: Clinical Otolaryngology
Ozan Kuduban
Tonsillectomy is one of the most frequently performed elective operations throughout the world. Although conventional methods are still valid, transoral robotic surgery (TORS) is preferred in some special situations. In this report, we will discuss the usage and reliability of TORS in the revision tonsillectomy procedure.
August 17, 2016: Journal of Craniofacial Surgery
Matthew C Ward, Shlomo A Koyfman
Transoral Robotic Surgery (TORS) is a fascinating new technology allowing for excellent functional outcomes after resection of head and neck tumors that previously required morbid surgical approaches for access. With a new technology, however, come new questions as to optimal patient selection and its impact on adjuvant therapy considerations. Here we review the issues most pertinent to a radiation oncologist adapting to the use of TORS. Patient selection, indications for adjuvant radiotherapy, radiation dose and target volumes are discussed...
September 2016: Oral Oncology
Alice N Weaver, Tiffiny S Cooper, Shi Wei, William R Carroll, Eben L Rosenthal, Eddy S Yang
BACKGROUND: Human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (SCC) has improved clinical outcomes compared to HPV-negative disease. However, the biology underlying differences in prognosis remains unclear. METHODS: We characterized the expression of DNA-protein kinase catalytic subunit (DNA-PkCS ), a key DNA repair protein also associated with tumor progression, in 29 cases of oropharyngeal SCCs and correlated our findings with HPV status and disease recurrence...
August 10, 2016: Head & Neck
Takehiro Sejima, Shuichi Morizane, Kazunori Fujiwara, Keigo Ashida, Hiroaki Saito, Yuji Taniguchi, Hiroshige Nakamura, Atsushi Takenaka
BACKGROUND: To ensure safe performance in robotic surgery, the Minimal Invasive Surgery Center (MISC) is composed of the anesthesiology department, five surgery departments and co-medical staff in our institution. The objective of this study was to evaluate the outcomes of different types of robotic surgeries for cancer treatment (n = 326) from different surgery departments in the MISC. METHODS: The outcomes of robot-assisted radical prostatectomy (RARP), partial nephrectomy (RAPN), transoral robotic surgery (TORS) for pharyngeal cancer, and robotic surgery for lung, gastric and rectal cancer were evaluated using the similar concept of pentafecta in RARP...
June 2016: Yonago Acta Medica
Ryan Sload, Natalie Silver, Basit Abjul Jawad, Neil D Gross
The incidence of oropharyngeal squamous cell carcinoma (OPSCC) is on the rise. This is largely due to the rapid increase in HPV positive OPSCC, which has been shown to confer a survival advantage. HPV negative OPSCC, however, has a more aggressive tumor biology and is a challenge to treat with standard current therapies. Chemoradiation has demonstrated poor locoregional control in HPV negative OPSCC, and open surgeries are associated with high morbidity. Transoral robotic surgery (TORS) has been proposed as an option to both intensify treatment and decrease surgical morbidity for patients with HPV negative OPSCC...
September 2016: Current Oncology Reports
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