ImportanceSeveral international guidelines have endorsed more conservative treatment of low-risk differentiated thyroid cancer (LRDTC), yet patients are facing more treatment options with similar oncologic outcomes and are expressing feelings of confusion, dissatisfaction, and anxiety. Shared decision-making, which considers the patient’s values and preferences along with the most reliable medical evidence, has been proposed to optimize patient satisfaction in the context of the current clinical equipoise.ObjectivesTo understand key individual and behavioral factors affecting the patient and clinician decision-making process in treatment decision for LRDTC.Evidence ReviewThis systematic review and meta-ethnography involved a comprehensive literature search of MEDLINE, Embase, PubMed, and CINAHL databases for qualitative and mixed-method studies on patient and clinician experiences with the decision-making process for LRDTC treatment. The quality of the studies was assessed using the Mixed Methods Appraisal Tool; meta-ethnography was used for data analysis. Primary and secondary themes of the included studies were extracted, compared, and translated across articles to produce a lines-of-argument synthesis.FindingsOf 1081 publications identified, 12 articles met the inclusion criteria. The qualitative synthesis produced 4 themes: (1) a bimodal distribution of patient preferences for treatment decisions; (2) clinician anxiety affected equipoise and biased their recommendations; (3) clinicians struggled to identify patient concerns and preferences; and (4) the clinician-patient relationship and psychosocial support were key to shared decision-making but were frequently overlooked.Conclusions and RelevanceThe findings of this systematic review and meta-ethnography emphasize the need for better patient-clinician communication, particularly with respect to eliciting patient concerns and preferences. With an ever-increasing pool of thyroid cancer survivors, future efforts should be directed at establishing and evaluating tools that will aid in shared decision-making for treatment of patients with LRDTC.Trial RegistrationPROSPERO Identifier: CRD42022286395

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Early larynx cancer detection plays a crucial role in improving treatment outcomes and recent studies have shown promising results in using artificial intelligence for larynx cancer detection. Artificial intelligence also has the potential to enhance transoral larynx microsurgery. This narrative review summarizes the current evidence regarding its use in larynx cancer detection and potential applications in transoral larynx microsurgery. The utilization of artificial intelligence in larynx cancer detection with white light endoscopy and narrow-band imaging helps improve diagnostic accuracy and efficiency. It can also potentially enhance transoral larynx microsurgery by aiding surgeons in real-time decision-making and minimizing the risk of complications. However, further prospective studies are warranted to validate the findings, and additional research is necessary to optimize the integration of artificial intelligence in our clinical practice.

Background Excessive flexion of the neck and upper back from severe kyphosis of the thoracic spine may limit treatment options for head and neck cancer (HNC). Methods We describe an innovative approach to transoral robotic surgery (TORS) in a patient with severe thoracic kyphosis and oropharyngeal squamous cell carcinoma (OPSCC) who was unsuitable for definitive radiotherapy. Results Detailed discussion of management pathway, perioperative considerations, and surgical challenges is presented. TORS lateral oropharyngectomy was successfully performed with the robotic system docked from the caudal end in a modified Trendelenburg position. Conclusions With appropriate surgical and anesthetic planning, TORS for patients with severe thoracic kyphosis is a feasible and suitable treatment.

BackgroundThe purpose of this study was to determine the feasibility of the novel technique of intra‐cavitary saline‐aided ultrasound (US) guided transoral biopsy or excision of retropharyngeal nodes.MethodsWe followed the IDEAL 2a framework to develop this technique. Procedures were performed between July 2020 and July 2022 at a tertiary head and neck center.ResultsFive patients in total underwent an ultrasound‐guided biopsy of a retropharyngeal node. They underwent seven procedures between them: three transoral robotic surgery (TORS) procedures, three fine needle aspirations (FNA) and/or core biopsy procedures, and one US assessment under general anesthetic. The six patients with histology taken (three TORS and three FNA/core biopsies) all had diagnostically adequate samples enabling appropriate treatment planning. There were no significant complications from the procedure.ConclusionSaline‐aided US‐guided biopsy of a retropharyngeal node is a safe and useful tool enabling accurate tissue sampling and tumor excision and ongoing appropriate treatment planning.