Current Status of Transoral Surgery for Patients With Early-Stage Pharyngeal and Laryngeal Cancers in Japan

Abstract

As the laryngopharynx is closely related to swallowing, speech, and phonation, it is necessary to consider not only disease control but also a minimally invasive approach for the treatment of laryngopharyngeal cancer. Transoral surgery has been reported to be a minimally invasive method for treating these diseases. Transoral videolaryngoscopic surgery (TOVS) and endoscopic laryngo-pharyngeal surgery (ELPS) have been developed in Japan and recently emerged as treatments for patients with early stage pharyngeal and laryngeal cancers. However, securing an appropriate field of view and a narrow operating space during TOVS or ELPS are critical issues to be resolved for these surgeries. The clinical significance and safety of transoral robotic surgery (TORS) using the da Vinci Surgical System have been widely reported to provide surgeons with increased visualization and magnification, resulting in precise surgical margins and rapid functional recovery. In this context, a multi-institutional clinical study was conducted to evaluate the treatment outcomes of TORS for the treatment of laryngopharyngeal cancer in Japan, and the da Vinci Surgical System for oral robot-assisted surgery for these diseases was approved by the Pharmaceutical Affairs Agency in August 2018. This review provides an overview of the therapeutic effects of TOVS, ELPS, and TORS, with a particular focus on these therapeutic results in Japan.

Transoral Robotic-Assisted Neurosurgery for Skull Base and Upper Spine Lesions

“…Pathologies in the infratemporal fossa and parapharyngeal fossa are rare and usually treated by otolaryngology, not neurosurgery. Currently, lesions in the middle and inferior pharynx are commonly treated by the da Vinci robot via a transoral approach [ 32 ]. Kupferman et al [ 8 ] reported that it was possible to suture in deep-seated lesions, especially the anterior cranial fossa, using robotic arms, in which the arms were introduced by a bilateral transmaxillary transantral approach to the nasal cavity.…”

“…Currently, lesions in the middle and inferior pharynx are commonly treated by the da Vinci robot via a transoral approach. 32 Kupferman et al 8 reported that it was possible to suture in deep-seated lesions, especially the anterior cranial fossa, using robotic arms, in which the arms were introduced by a bilateral transmaxillary transantral approach to the nasal cavity. This was the first reported approach of 8-mm robotic arms through the nasal cavity.…”

Clinical Outcomes of Curative Intent Radiotherapy by Helical Tomotherapy for Laryngeal Squamous Cell Carcinoma: A Retrospective Analysis in a Tertiary Referral Center

“…The late toxicities affecting voice and swallowing function among the treatment groups could affect non-cancer-related deaths. In recent years, novel surgical techniques for laryngopharyngeal cancer, known as endoscopic laryngopharyngeal surgery and transoral video laryngoscopic surgery, have been developed using endoscopic approaches [ 23 ]. Both approaches are suitable for early-stage cases of laryngeal and hypopharyngeal cancers.…”

Etiology, diagnosis, treatment, and prevention of human papilloma virus-associated oropharyngeal squamous cell carcinoma

“…Transoral videolaryngoscopic surgery (TOVS) and endoscopic laryngo-pharyngeal surgery (ELPS) have been developed in Japan. The da Vinci Surgical System for TORS was approved by the Pharmaceutical Affairs Agency in August 2018 and covered by national insurance in April 2022 [ 34 ]. Sano et al showed that TORS has an advantage over the other non-robotic modalities in that it has a lower rate of positive surgical margin [ 35 ].…”