Transoral Robotic Surgery using the Thulium-YAG Laser: A Prospective Study

Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic School of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
Archives of otolaryngology--head & neck surgery (Impact Factor: 1.75). 02/2012; 138(2):158-66. DOI: 10.1001/archoto.2011.1199
Source: PubMed

ABSTRACT To compare thulium:YAG laser-assisted transoral robotic surgery (TY:TORS) and conventional electrocautery-equipped TORS (EC:TORS) in patients undergoing transoral resection of upper aerodigestive tract malignant neoplasms.
Prospective matched cohort study.
Tertiary academic referral center.
Fifteen patients undergoing TY:TORS were matched on the basis of tumor site, clinical T stage, sex, and age with 30 control subjects undergoing EC:TORS.
The primary outcome was a comparison between the feasibility of TY:TORS compared with EC:TORS. The secondary outcome was a comparison between the safety and functional outcome of TY:TORS compared with EC:TORS in patients undergoing resection of upper aerodigestive tract malignant neoplasms.
All the tumors underwent complete excision with negative margins. Estimated blood loss was minimal (<150 mL) for 87% of TY:TORS patients (13 of 15) and 63% of EC:TORS controls (19 or 30). Intraoperative pharyngotomy was reported in 8% of TY:TORS patients (1 of 13) and 42% of EC:TORS controls (11 of 30) (P = .03). Postoperative pain was greater in EC:TORS compared with TY:TORS (P = .02). No statistically significant differences were noted in hemostasis, postoperative bleeding rates, or other complications.
Compared with EC:TORS, TY:TORS seems feasible and safe. In addition, TY:TORS resulted in fewer intraoperative pharyngotomies and less postoperative pain than did EC:TORS, which may be because of decreased collateral thermal damage, improved visualization, and finer cutting using the thulium laser.

  • Current problems in cancer 09/2012; DOI:10.1016/j.currproblcancer.2012.07.002 · 1.00 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Within the last years transoral robotic surgery (TORS) has gained importance in the resection of head and neck tumors, especially in North America. In contrast only few groups in Germany have studied this system so far. In respect to potential future developments in surgical robotic systems it seems reasonable to deal with this system.17 patients with tumors of the oropharynx, the base of tongue or the supraglottic area were treated with TORS in our clinic, between May 2011 and June 2012. In a prospective study we analyzed the exposure, visualization and resectability of these tumors using the da Vinci-system. In addition, set up and operation time, as well as costs were evaluated.All neoplasms of the oropharynx (n=9) and the tongue base (n=5) could be well exposed, visualized and resected. In the supraglottic area (n=3) 2 tumors could not be properly exposed and therefore resection was converted to a transoral microscopic laser approach. Resection with the cautery spatula tip or the Tm:YAG-laser fibre caused wide coagulation zones, but resulted in good hemostasis. The costs for the medical equipment and the leasing rate were 6 280 € per case at our institution.Tumors of the tongue base and oropharynx could be easily visualized with help of the da Vinci-system. The resection of supraglottic tumors can be challenging, due to the arrangement of the robotic-arms and the narrow anatomic conditions. Despite its high costs, the da Vinci-system is a potentially interesting supplementation to existing surgical techniques.
    Laryngo-Rhino-Otologie 11/2012; 91(12). DOI:10.1055/s-0032-1327663 · 0.99 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Introducción. La cirugía robótica transoral supone un paso adelante en la evolución de la cirugía mínimamente invasiva en cabeza y cuello, que optimiza las dos exigencias básicas de este tipo de abordajes quirúrgicos: excelente visión y libertad de manipulación. Su desarrollo desde el año 2009 ha sido explosivo. Material y Métodos. Se describen los aspectos técnicos del sistema de cirugía robótica da Vinci y los procedimientos quirúrgicos básicos (amigdalectomía radical, exéresis de base de lengua y laringectomía supraglótica). A través de una revisión de la literatura se presenta la experiencia clínica disponible. Resultados. La cirugía robótica transoral se ha aplicado principalmente en el cáncer de cabeza y cuello. Se han publicado ya series numerosas con resultados funcionales y oncológicos comparables a las técnicas estándar. La cirugía robótica amplia particularmente las posibilidades de abordaje transoral en la orofaringe. El abordaje quirúrgico de la base de la lengua abre también nuevas posibilidades en el manejo de la apnea del sueño. Los abordajes robóticos a la base de cráneo siguen en terreno experimental. Discusión. Los datos disponibles avalan el uso de la cirugía robótica transoral y orientan hacia cambios sustanciales en los protocolos de manejo del cáncer de cabeza y cuello.
Show more