Transoral Robot-Assisted Surgery in Supraglottic and Oropharyngeal Squamous Cell Carcinoma: Laser Versus Monopolar Electrocautery

Abstract

Background: Monopolar electrocautery (EC) is the surgical cutting and haemostatic tool most commonly used for transoral robotic surgery (TORS). The aim of this study was to retrospectively compare EC efficacy in the treatment of patients affected by T1 or T2 oropharyngeal and supraglottic squamous cell carcinomas with the more recently introduced laser fibres. Methods: We considered all TORS patients admitted to our department from January 2010 to June 2019. The outcomes of patients treated with Thulium: yttrium aluminium garnet (YAG) laser (TY-TORS), CO2 laser (CO2-TORS) and EC (EC-TORS) were analysed in order to assess surgical performances, functional outcomes and postoperative complications. Results: Twenty patients satisfied the enrolling criteria, of which nine underwent laser-TORS, and the remaining 11 underwent EC-TORS. In all candidates, TORS procedures were completed without the need for microscopic/open conversion. Close or positive margins were significantly more frequent in EC-TORS (p = 0.028). A considerable difference was found in overall functional parameters: times of nasogastric tube and tracheostomy removal and time of hospital discharge were significantly shorter in laser-TORS (p = 0.04, p = 0.05, p = 0.04, respectively). Conclusions: Laser-TORS showed better results in comparison with EC-TORS in term of tumour resection margins and patient functional outcomes. Our findings can be justified with the greater tissue thermal damage caused by EC-TORS, despite prospective randomized trials and increased patient numbers being needed to confirm these preliminary conclusions.

Novel Approaches in Surgical Management: How to Assess Surgical Margins

“…A paradoxical fact on recommendations for margin width lies in the techniquedependent threshold defining "clear margins". A cancer of the upper aerodigestive tract would be defined as completely resected with a threshold of 5 mm of pathologically uninvolved tissue if operated on with open surgery, 2-5 mm if through transoral robotic surgery, 0.5-2 mm if via transoral laser surgery, and regardless of metric measurements provided that adjacent structures are not infiltrated in case endoscopic transnasal resection has been performed [27][28][29][30][31][32][33][34][35][36]. On the one hand, this difference is understandable as it expresses the need to define as either "adequate" or "inadequate" a resection performed with a given technique.…”

HPV‐positive oral papillomas in an adolescent—A diagnostic dilemma

“…However, scarring may occur and lasting clearance of papillomas can be difficult to achieve. 7 , 8 A previous study indicates that CO 2 laser ablation of respiratory papillomas prevented clinical recurrence for 5 years among just 17% of patients. 7 Our case utilized a multimodality approach with both excision and CO 2 laser ablation, but did demonstrate multiple recurrences, likely due to a more conservative ablation initially.…”

Preclinical implementation of a steerable, Da Vinci Xi® compatible CO2‐laser fibre carrier for transoral robotic surgery (TORS): A cadaveric feasibility study

“…12 After the introduction of hollow wave guides, different authors implemented CO 2 -laser technology during TORS procedures, illustrating feasibility and safety in a preclinical 14 and clinical setting in which malignant tumours in the oropharynx, supraglottic larynx and hypopharynx were addressed by the integrated combination of CO 2 -laser and robotic technology. [14][15][16]18,[24][25][26] The histologic observation of minimal thermal damage to surrounding tissues related to the use of a (flexible) CO 2 -laser may lead to substantial advantages for patients. This…”