Alternative Applications of Trans-Oral Robotic Surgery (TORS): A Systematic Review

Abstract

Background: The role of robotic surgery in the field of oncology has been widely described, in particular for the tumours of the oropharynx and larynx, but its efficacy for benign pathology is inconsistent. Methods: An exhaustive review of the English literature on trans-oral robotic surgery (TORS) for benign conditions was performed using PubMed electronic database. Results: The research was performed in March 2019 and yielded more than eight hundred articles, with 103 meeting the inclusion criteria and considered in the present study. Conclusions: The application of TORS for the treatment of obstructive sleep apnoea syndrome seems to be particularly well documented. Additionally, there exists a special interest in its use where high precision in limited anatomic space is required. There are still different structural and economic limitations for the application of TORS, however, the progressive technologic innovations and the increasing adoption of robotic surgery seem to encourage the uptake of this technique.

Quality of Life and Excessive Daytime Sleepiness in Adults with Obstructive Sleep Apnea Who Are Treated with Multilevel Surgery or Adherent to Continuous Positive Airway Pressure

“…This combined multilevel surgical approach is a standardized protocol, well described in the literature, that has been performed with good results for more than 10 years. Surgical steps were performed in all patients as reported in the original study of Vicini et al [8,10,15].…”

“…The ESS score (the sum of the 8-item scores, 0-3) can range from 0 to 24. The higher the ESS score, the higher that person's average sleep propensity in daily life, or their 'daytime sleepiness' [10][11][12][13][14][15][16][17].…”

Quality of life improvement after Obstructive Sleep Apnea treatment: Continuous Positive Airway Pressure versus Multilevel Transoral Robotic Surgery.

“…This combined multilevel surgical approach is a standardized protocol, well described in the literature, that has been performed at our center for more than 10 years. Surgical steps were performed in all patients as reported in the original study of Vicini et al (8,10,15).…”

Preoperative predictors of difficult oropharyngeal exposure for transoral robotic surgery: The Pharyngoscore

“…Transoral robotic surgery (TORS) is now well‐integrated in the armamentarium of the head and neck surgeon for the treatment of malignant neoplasms of the head and neck, 1–11 as well as in the management of unknown primary tumors presenting with cervical lymph node metastasis 12,13 and of benign neoplasms and diseases such as obstructive sleep apnea syndrome (OSAS) 14–17 . Within the upper aerodigestive tract, the oropharynx is the area most frequently treated with TORS 2 .…”

“…Transoral robotic surgery (TORS) is now well-integrated in the armamentarium of the head and neck surgeon for the treatment of malignant neoplasms of the head and neck, [1][2][3][4][5][6][7][8][9][10][11] as well as in the management of unknown primary tumors presenting with cervical lymph node metastasis 12,13 and of benign neoplasms and diseases such as obstructive sleep apnea syndrome (OSAS). [14][15][16][17] Within the upper aerodigestive tract, the oropharynx is the area most frequently treated with TORS. 2 Historically, oropharyngeal cancers have been treated with open surgery and postoperative radiotherapy (RT), bringing good oncological results but at a cost of significant morbidity.…”