How to optimize laryngeal and hypopharyngeal exposure in transoral robotic surgery

Abstract Objective The aim of this study was to present the various strategies adopted in our center to improve and overcome problems with exposure of the operative field in 48 patients who underwent TORS for the treatment of laryngeal and hypopharyngeal cancer. Methods We present our operative and...

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Bibliographic Details
Published in:Auris, nasus, larynx nasus, larynx, 2013-06, Vol.40 (3), p.312-319
Main Authors: De Virgilio, Armando, Park, Young Min, Kim, Won Shik, Baek, Seung Jae, Kim, Se-Heon
Format: Article
Language:English
Subjects:
Aged
Exposure
Female
Humans
Hypopharyngeal Neoplasms - surgery
Hypopharynx
Laryngeal Neoplasms - surgery
Larynx
Male
Muscle Relaxants, Central - therapeutic use
Otolaryngology
Otorhinolaryngologic Surgical Procedures - methods
Preoperative Care
Prospective Studies
Robotics
Surgical Instruments
Tracheotomy
Transoral robotic surgery
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Summary:Abstract Objective The aim of this study was to present the various strategies adopted in our center to improve and overcome problems with exposure of the operative field in 48 patients who underwent TORS for the treatment of laryngeal and hypopharyngeal cancer. Methods We present our operative and preoperative treatment protocols for patients undergoing TORS for laryngeal and hypopharyngeal cancer. In particular, we emphasize the role of preoperative exposure assessment and the usefulness of simple measures to overcome problems with exposure of the operative field. Results In 12 patients (25%), we experienced difficult laryngeal–hypopharyngeal exposure. However the correct positioning of the robotic arms, the proper use of the laryngeal and tongue blade and some simple maneuvers, such as the anterior traction of the tongue and the partial epiglottectomy, ensured the feasibility of TORS with negative margins in all patients. Conclusion In TORS, the exposure of larynx and hypopharynx can be difficult, but the adoption of certain methods may make it possible in most patients. An accurate preoperative evaluation under general anesthesia is the primary strategy for reducing the number of cases terminated intraoperatively. Currently, TORS is not feasible in all patients, but in our opinion, reductions in the size of robotic equipment and development of new devices will extend the application of TORS to a larger number of patients.
ISSN:0385-8146
1879-1476
DOI:10.1016/j.anl.2012.07.017