TransOral UltraSonic surgery (TOUSS) for oral cavity, oropharyngeal and supraglottic malignancy: A prospective study of feasibility, safety, margins, functional and survival outcomes

• Published in: Oral oncology 2022-01, Vol.124, p.105643-105643, Article 105643
• Main Authors: Sakthivel, Pirabu, Thakar, Alok, Fernández-Fernández, Mario M., Panda, Smriti, Sikka, Kapil, Amit Singh, Chirom, Kumar, Rajeev, Kakkar, Aanchal, Sharma, Atul, Bhasker, Suman
• Format: Article
• Language: English
• Subjects: Feasibility Studies; Head-Neck; Humans; Laryngeal Neoplasms - surgery; Margins of Excision; Mouth - surgery; Oropharyngeal Neoplasms - surgery; Oropharynx; Prospective Studies; Squamous cell carcinoma; TORS; TOUSS; Treatment Outcome; Ultrasonic Surgical Procedures
• ISSN: 1368-8375; 1879-0593
• DOI: 10.1016/j.oraloncology.2021.105643

•TransOral Ultrasonic Scalpel Surgery (TOUSS) is a feasible and safe Trans-Oral option for appropriately selected Oropharyngeal and Supraglottic cancer.•Similar oncologic and functional outcomes as with TORS are demonstrated in this initial experience.•The technique is promising in comparison to TORS in terms of improved hemostasis, intraoperative margin assessment facilitation by NBI, its technical feasibility in patients with limited mouth opening, and relative cost-effectiveness.•Further developments in technology and refinement of instrumentation specific to head-neck surgery are likely to lead to its wider adoption for minimally invasive trans-oral oncosurgery. With the advent of TransOral Robotic Surgery (TORS) the ease of transoral procedures has been dramatically improved. TORS is already established for its feasibility, functional and oncological outcomes for selected lesions of oral cavity, oropharynx and laryngopharynx. This study reports on preliminary results with TransOral UltraSonic Surgery (TOUSS) for oncologic resections of oral cavity, oropharyngeal and supraglottic malignancies. Eighteen patients with malignancies of oral cavity, oropharynx and supraglottis underwent TOUSS with simultaneous neck dissection and adjuvant therapy as indicated, from January 2018 to April 2019. Essential equipment included the FK-retractor (Gyrus Medical, Tuttilngen, Germany) for TransOral exposure, the Olympus ENDOEYE Flex 5 mm 2D/10 mm 3D deflecting tip video laparoscopes, and 35 cm long ultrasonic harmonic scalpel (Thunderbeat). Parameters evaluated include tumor staging, mouth opening, TOUSS setup time, TOUSS primary removal time, surgical margins, blood transfusions, tracheostomy, postoperative complications, enteral feeding and resumption of oral diet, duration of hospital stay, and survival outcomes. Eighteen patients underwent complete TransOral UltraSonic Surgery (TOUSS), with simultaneous unilateral or bilateral neck dissection. No procedure was abandoned intraoperatively due to difficulty in extirpation of the tumor. Margins were negative for ten patients (55.6%), close in five (27.8%), and positive in three patients (16.7%). Average TOUSS set-up time was 22.5 min (range, 10–30 min) and average TOUSS primary tumor removal time was 35.3 min (range, 15–60 min). Patients started tolerating oral feeds even in the second post op day (mean 6 days), and transitioning to complete oral feeds with removal of the nasogastric tube was achieved in all (mean, 16