Transoral robotic surgery of the oropharynx: Clinical and anatomic considerations

Abstract

Transoral robotic surgery provides a mechanism to approach tumors of the upper aerodigestive tract through a natural body orifice--the mouth. The technique has been applied most often to malignant tumors of the oropharynx. The use of this technique, however, forces the surgeon to view the anatomy from a different vantage point. Head and neck surgeons are accustomed to the oropharynx from lateral to medial. The transoral approach forces surgeons to consider the anatomy from the oral cavity and oropharynx medial perspective. This article will discuss the relevant anatomy, operative goals, robotic technique, and clinical considerations of transoral robotic surgery of the oropharynx.

A cadaveric study quantifying the anatomical landmarks of the facial artery and its parapharyngeal branches for safe transoral surgery

“…Although these newer approaches aim to surgically resect tumors decreasing postoperative stay and functional disruption, many surgeons are apprehensive about operating in this region via a limited access approach. The description of anatomy and techniques for the transoral approach is somewhat limited and often repeated in the current literature . Adding to this body of knowledge would enhance the surgeons ability to safely navigate the parapharyngeal space (PPS) while limiting inadvertent risk to major vessels .…”

Determination of biometric measures to evaluate patient suitability for transoral robotic surgery

“…Oropharyngeal cancer accounts for about 10% of these cases and is rising as a direct result of human papillomavirus infection . Historically, the treatment of oropharyngeal cancer has involved major and often debilitating open surgery to achieve sufficient access for oncologic clearance . Minimally invasive head and neck surgery is desirable because it reduces the morbidity associated with open surgery and transoral robotic surgery (TORS) represents the latest development in this field.…”

A description of arterial variants in the transoral approach to the parapharyngeal space

“…Injury to any of these structures can lead to immediate or delayed hemorrhage, which can be life threatening (Hans et al, ; Schrock et al, ). To avoid such complications, we need to improve our understanding of the anatomy of this area (Moore et al, ). Because TORS is relatively novel, only a few studies have described the relevant surgical anatomy (Weinstein et al, ; Dallan et al, ; Moore et al, ).…”

“…To avoid such complications, we need to improve our understanding of the anatomy of this area (Moore et al, ). Because TORS is relatively novel, only a few studies have described the relevant surgical anatomy (Weinstein et al, ; Dallan et al, ; Moore et al, ). There is, therefore, a critical need for studies that describe the vascular anatomy of the PPS as encountered through a transoral approach.…”