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Trans oral robotic surgery

Stanislav Lazarev, Blagoja Todorov, James Tam, Vishal Gupta, Brett A Miles, Nancy Lee, Richard L Bakst
PURPOSE: Trans-oral robotic surgery (TORS) followed by adjuvant radiation therapy (RT) is becoming popular in treating node-positive tonsillar squamous cell carcinoma (SCC). One potential benefit is eliminating irradiation of the primary site when the tumor is widely resected, and targeting the neck only. This study assessed whether omitting the tumor bed provides any dosimetric or clinical advantage. METHODS AND MATERIALS: We identified 21 patients with primary tonsillar SCC that were treated with TORS followed by RT to the ipsilateral neck and primary (N+P) site...
March 2017: Practical Radiation Oncology
Benoit Morisod, Ioana I Venara-Vulpe, Stephen Alzuphar, Yan Monnier, Massimo Bongiovanni, Patric Hagmann, Hanan Bouchaab, Jean Bourhis, Christian Simon
BACKGROUND: We investigated in a prospective cohort of patients treated with trans-oral robotic surgery (TORS) for oropharyngeal cancer (OPC), who were selected for the absence of radiographic extra-capsular extension (ECS) and surgically revised for inadequate margins, the possibility of reducing adjuvant radiation (RT)/chemo-radiation therapy (CRT) without jeopardizing tumor control and functional outcome. METHODS: We conducted a prospective observational cohort of patients treated with TORS for oropharyngeal cancer...
February 11, 2017: Head & Neck
Giuseppe Meccariello, Filippo Montevecchi, Alberto Deganello, Giovanni D'Agostino, Chiara Bellini, Ermelinda Zeccardo, Claudio Vicini
Trans Oral Robotic Surgery (TORS) is a prominent surgical approach for the resection of oropharyngeal tumors without division of the lip and mandible. Some defects following TORS are large and complex enough to benefit soft-tissue coverage. The pedicled temporalis muscle flap is a versatile and reliable flap and may be a valid option to reconstruct defects of the lateral pharyngeal wall and partial soft palate.
December 19, 2016: Auris, Nasus, Larynx
T J Gal, Brian Hixon, Paul Zhang
This case report describes the use of trans-oral robotic surgery (TORS) for the excision of a combined laryngocele. Mixed or combined laryngoceles extend from the supraglottic larynx through the thyrohyoid membrane into the neck. Surgical excision for these benign lesions often requires combined external (transcervical) and internal (transoral endoscopic) approaches which carry significant morbidity. We present the case of a 37-year-old male who was diagnosed with a large laryngopyocele and was subsequently managed with a transoral excision using the da Vinci Si surgical robot system...
December 19, 2016: Journal of Robotic Surgery
James Howard, Liam Masterson, Raghav C Dwivedi, Faruque Riffat, Richard Benson, Sarah Jefferies, Piyush Jani, James R Tysome, Chris Nutting
BACKGROUND: More than 400,000 cases of oropharyngeal squamous cell carcinoma (OPSCC) are diagnosed each year worldwide and the incidence is rising, partly as a result of human papillomavirus. Human papillomavirus-associated OPSCC affects younger patients and often presents at a higher stage; however, it is associated with a better prognosis.Until recently, first-line management of OPSCC involved chemoradiotherapy, as research had demonstrated comparable survival outcomes when compared with open surgery, with significantly decreased morbidity...
December 11, 2016: Cochrane Database of Systematic Reviews
G Y Wu, F S Lin
Trans-oral laporascopic thyroidectomy is a innovative technique that incoporated the concept of natural orifice transluminal endoscopic surgery. Compare to other endoscopic thyroidectomy, trans-oral laporascopic thyroidectomy is characterised with no scar in the body surface, better cosmetic results and conforms to the concept of minimally invasive surgery. At present, trans-oral laporascopic thyroidectomy is still in the initial stages of clinical application and gains a great deal of attention from surgeons all over the world...
November 1, 2016: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
Matthew C Miller
This study describes a novel exposure technique for base of tongue trans-oral robotic surgery (BOT TORS) and early experience with it. The technique discussed involves placement of a suture through the mobile tongue with distraction and suspension of the tongue to the operating table. TORS is then performed per previously described techniques. In our series, 13 patients with either benign or malignant mass lesions involving the tongue base were treated with TORS at a tertiary academic medical center. We reviewed the rates of adequate exposure, console time, adequacy of resection (in malignant cases), complication rates, and costs associated with this technique...
December 2016: Journal of Robotic Surgery
Giovanni Cammaroto, Filippo Montevecchi, Giovanni D'Agostino, Ermelinda Zeccardo, Chiara Bellini, Bruno Galletti, Medhat Shams, Hesham Negm, Claudio Vicini
Coblation tongue surgery and Trans-oral robotic surgery (TORS) proved to be the most published therapeutical options for the treatment of patients affected by obstructive sleep apneas (OSAHS). A systematic review of the literature and an analysis of the data are presented. The mean rates of failure were 34.4 and 38.5 %, respectively in TORS and Coblation groups. Complications occurred in 21.3 % of the patients treated with TORS and in 8.4 % of the patients treated with Coblation surgery. TORS seems to give slightly better results, allowing a wider surgical view and a measurable, more consistent removal of lingual tissue...
February 2017: European Archives of Oto-rhino-laryngology
Takashi Suda, Shinji Kaneda, Ayumi Hachimaru, Daisuke Tochii, Ryo Maeda, Sachiko Tochii, Yasushi Takagi
BACKGROUND: We have previously reported on single-port thymectomy (SPT), which involves performing thymectomy via a single subxiphoid incision, and trans-subxiphoid robotic thymectomy (TRT), which is performed using the da Vinci surgical system. The aim of this study was to investigate the early surgical outcomes of thymectomy using the SPT and TRT subxiphoid approaches and to discuss their appropriate uses. METHODS: The subjects included 80 patients who underwent thymectomy via a subxiphoid approach...
March 2016: Journal of Thoracic Disease
Małgorzata Wierzbicka, Krzysztof Szyfter, Piotr Milecki, Krzysztof Składowski, Rodryg Ramlau
The treatment paradigms for head and neck squamous cell cancer (HNSCC) are changing due to the emergence of human papillomavirus-associated tumors (HPV-related), possessing distinct molecular profiles and responses to therapy. Retrospective studies have suggested that HPV-related HNSCCs are more frequently cured than those caused by tobacco. Current clinical trials focus on the reduction of treatment-related toxicity and the development of HPV-targeted therapies. New treatment strategies include: 1) dose reduction of radiotherapy, 2) the use of cetuximab instead of cisplatin for chemo-radiation 3) less invasive surgical options, i...
2015: Contemporary Oncology Współczesna Onkologia
Ramazan Gun, Enver Ozer
Traditional external surgical approaches have been used for the surgical management of the oropharyngeal and laryngeal tumors. Trans-oral robotic surgery allows surgeon to operate oropharyngeal and supraglottic tumors through the mouth with preservation of functions. The surgeons must be knowledgeable about the anatomy of the oral cavity and oropharynx medial to lateral perspective. In this article, we will describe the relevant inside out surgical anatomy and its clinical implications for trans-oral robotic surgery...
December 2015: Journal of Surgical Oncology
Khurram Khan, Tom Dobbs, Marc C Swan, Gregory S Weinstein, Tim E E Goodacre
BACKGROUND/AIM: Robot-assisted surgery has become increasingly routine, replacing open and laparoscopic techniques in certain domains, with recent extension to head and neck surgery through trans-oral access. Some advantages of the robot-assisted surgery include the ability to access confined spaces, enhanced dexterity instrumentation with intuitive movement, motion scaling, tremor elimination and three-dimensional (3D) endoscopic viewing with true depth perception. The aim of this study was to investigate the technical feasibility of trans-oral robotic cleft surgery (TORCS) to access the posterior pharyngeal wall and palate for potential use in the cleft population...
January 2016: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
N Dawe, J Patterson, J O'Hara
BACKGROUND: Trans-oral surgical and non-surgical management options for oropharyngeal squamous cell carcinoma (OPSCC) appear to offer similar survival outcomes. Functional outcomes, in particular swallowing, have become of increasing interest in the debate regarding treatment options. Contemporary reviews on function following treatment frequently include surrogate markers and limit the value of comparative analysis. OBJECTIVES OF REVIEW: A systematic review was performed to establish whether direct comparisons of swallowing outcomes could be made between trans-oral surgical approaches (trans-oral laser microsurgery (TLM)/trans-oral robotic surgery (TORS)) and (chemo)radiotherapy ((C)RT)...
August 2016: Clinical Otolaryngology
Ryan P Goepfert, Chienying Liu, William R Ryan
BACKGROUND: Retropharyngeal metastases are uncommon but a well-known location for regional spread of well-differentiated thyroid carcinoma (WDTC). Surgeon-performed, trans-oral ultrasound (SP-TO-US) and trans-oral robot-assisted surgical (TORS) excision represent a unique combination of technology and techniques in the treatment of isolated retropharyngeal thyroid metastases. PATIENT FINDINGS: A patient with a history of T3N1b papillary thyroid carcinoma (PTC) previously treated with total thyroidectomy, left central and lateral neck dissection, and radioactive iodine presented with progressive elevations in serum thyroglobulin (Tg) from baseline of 0...
September 2015: American Journal of Otolaryngology
Balazs B Lörincz, Nikolaus Möckelmann, Chia-Jung Busch, Rainald Knecht
BACKGROUND: This is a single-institution prospective study in a tertiary care center to evaluate feasibility, completeness of resection, and functional outcomes for oropharyngeal squamous cell carcinoma (SCC) treated primarily with transoral robotic-assisted resection. METHODS: Thirty-five patients with T1 and T2 squamous cell carcinoma of the oropharynx were included. They underwent transoral robotic surgery (TORS) between September 2011 and April 2013, with a median follow-up time of 13 months...
November 2015: Head & Neck
B B Lörincz, R Knecht
The classic indications of TORS are still limited mostly to partial resections of the oropharynx, hypopharynx und supraglottic larnyx. In addition to these, there has been some promising applications towards broadening the limits of robotic assisted head and neck surgery and to perform a trans oral total laryngectomy (TORTL). Using the robotic assisted transoral approach for a total laryngectomy can reduce the risk of fistula formation after salvage laryngectomy effectively, avoiding a wide apron flap and with no plane dissected between the skin and the strap muscles...
September 2013: Laryngo- Rhino- Otologie
N Kokot, K Mazhar, K O'Dell, N Huang, A Lin, U K Sinha
Localized synovial cell sarcomas are treated with surgical resection followed by chemo-radiation. Surgical resection of synovial sarcoma of the oropharynx and hypopharynx involves lip-splitting mandibulotomy resulting in treatment related morbidity. We report the successful use of Trans Oral Robotic Surgery for resection of localized synovial sarcoma of the lateral pharyngeal wall in a 15 year old patient. We were able to achieve negative surgical margins and avoid open surgery with its associated morbidity...
June 2013: International Journal of Pediatric Otorhinolaryngology
Steven C Bonawitz, Umamaheswar Duvvuri
UNLABELLED: OBJECTIVES/HYPOTHOSES: TORS (Trans Oral Robotic Surgery) has been demonstrated to be an acceptable alternative to chemoradiation for the treatment of early stage malignant lesions of the oropharynx, with equivalent tumor control and enhanced functional outcomes. Surgical ablation of tumors of the oropharynx under conditions of limited access, however, creates the need to adapt the robotic platform to surgical reconstruction and to assess reconstructive outcomes. We present our experience with the Facial Artery Musculomucosal (FAMM) flap with robotic assistance for the reconstruction of defects of the soft palate...
April 2013: Laryngoscope
Anthony C Nichols, John Yoo, J Alex Hammond, Kevin Fung, Eric Winquist, Nancy Read, Varagur Venkatesan, S Danielle MacNeil, D Scott Ernst, Sara Kuruvilla, Jeff Chen, Martin Corsten, Michael Odell, Libni Eapen, Julie Theurer, Philip C Doyle, Bret Wehrli, Keith Kwan, David A Palma
BACKGROUND: The incidence of oropharyngeal squamous cell carcinoma (OPSCC) has markedly increased over the last three decades due to newly found associations with human papillomavirus (HPV) infection. Primary radiotherapy (RT) is the treatment of choice for OPSCC at most centers, and over the last decade, the addition of concurrent chemotherapy has led to a significant improvement in survival, but at the cost of increased acute and late toxicity. Transoral robotic surgery (TORS) has emerged as a promising alternative treatment, with preliminary case series demonstrating encouraging oncologic, functional, and quality of life (QOL) outcomes...
March 20, 2013: BMC Cancer
J De Ceulaer, C De Clercq, G R J Swennen
A systematic review of the literature concerning robotic surgery in oral and maxillofacial (OMF), craniofacial and head and neck surgery was performed. The objective was to give a clear overview of the different anatomical areas of research in the field of OMF, craniofacial and head and neck surgery, in all its fields (pre-clinical and clinical). The present indications are outlined and the critical reader is invited to assess the value of this new technology by highlighting different relevant parameters. A PubMed and Cochrane library search yielded 838 papers published between 1994 and 2011...
November 2012: International Journal of Oral and Maxillofacial Surgery
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