Transoral robotic surgery of the parapharyngeal space: A case series and systematic review

Chan, Jason Y. K.; Tsang, Raymond King‐Yin; Eisele, David W.; Richmon, Jeremy D.

doi:10.1002/hed.23557

Cited by 105 publications

(100 citation statements)

References 26 publications

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“…Furthermore, a number of authors avoid using this approach due to the risk of damaging the blood vessels and the potential for incomplete tumor extirpation (6,7,10). Robotic transoral surgery of the PPS tumor was previously reviewed, and the authors determined that the risk of violation of the capsule of a pleomorphic adenoma was most severe when the capsule was ruptured and tumor spillage occurred (28). In our opinion, this would produce an unacceptable risk to prognosis; tumor localization, size and suspicions of malignancy should be carefully reviewed prior to considering this approach.…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment of parapharyngeal space tumors: A report of 29 cases

Ijichi

Murakami

2017

Oncology Letters

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Abstract. The present study aimed to establish a strategy for parapharyngeal space (PPS) tumor surgery based on preoperative symptoms, clinical signs, imaging and histological examination. A retrospective cohort study was conducted with 29 adult patients who underwent surgery for primary PPS tumors from 2008-2015. The following data was obtained: Preoperative symptoms of the patient, histological type of the tumor, surgical approach and complications. Of the 29 patients who underwent surgery to remove a PPS tumor, 16 presented with neurogenic tumors and 13 with salivary gland tumors. The most common symptom was the presence of a neck mass. Preoperative computed tomography and magnetic resonance imaging were performed to evaluate the size and location of the tumors. The majority of the salivary gland tumors were located in the prestyloid space, whereas all neurogenic tumor cases were poststyloid. A total of 21 of the 29 patients (72.4%) underwent a preoperative fine needle aspiration (FNAC) examination. FNAC contributed to preoperative diagnosis in 9 of these cases (42.9%). In parotid tumors of the prestyloid space, facial nerve palsy was a common postoperative complication. In the case of neurogenic tumors, a common complication was the postoperative palsy of the nerve of tumor origin. The strategy for PPS surgery, from the preoperative diagnosis to the operative method, remains controversial. The data on pre-and postoperative symptoms, imaging and histological diagnosis, and the selection of surgical method depending on a neurogenic or salivary tumor origin in the present study indicated that improving the method of examination, carefully selecting the method of approach and accurately managing surgery leads to complete tumor removal, and that the use of nerve-preserving techniques may reduce the likelihood of complications.

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Section: Discussionmentioning

confidence: 99%

Surgical treatment of parapharyngeal space tumors: A report of 29 cases

Ijichi

Murakami

2017

Oncology Letters

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“…Both techniques provide means of accessing a range of anatomic sites in the head and neck that have traditionally been difficult to approach, and the growing familiarity with TORS has led to a rapid expansion of its indications [1,4,6,[8][9][10][11][12][13][14]. TORS is currently being used in the management of early-stage tumors, more advanced malignancies, tumor recurrences, deep neck space infections, tumors of unknown primary site, and comparatively benign conditions such as obstructive sleep apnea [1,[15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

Transoral endoscopic head and neck surgery (eHNS) for minor salivary gland tumors of the oropharynx

et al. 2017

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Background: Transoral endoscopic head and neck surgery (eHNS), including transoral laser microsurgery (TLM) and transoral robotic surgery (TORS), provides access to subsites in the head and neck that have traditionally been difficult to approach. Minor salivary gland tumors, while relatively uncommon, are frequently malignant and can occur at sites in the oropharynx accessible by transoral eHNS. Presented here is the largest review to date of patients with minor salivary gland tumors of the oropharynx managed with transoral eHNS as primary or salvage therapy. Methods: A retrospective chart review was performed, including data from 20 patients with minor salivary gland tumors of the oropharynx managed with transoral eHNS at 2 tertiary, academic medical centers. Details of tumor pathology, margin analysis, adjuvant therapy, and an assessment of oncologic outcome were included. Results: The base of tongue was the most common tumor site (75%). Adenoid cystic carcinoma (ACC) accounted for most cases (35%), and negative margins were obtained in most (95%) through an endoscopic-only approach. Overall, 50% of patients received post-operative radiation therapy. Postoperative complications were limited, with one patient (5%) returning to the OR for control of post-operative oropharyngeal bleeding. On average follow-up of 36 months, 90% of patients were alive with no evidence of recurrence.

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“…38 Transoral robotic surgery using the da Vinci surgical system (Intuitive Surgical, Inc.) has been extensively described in the literature for the management of middle cranial fossa skull base tumors, along with tongue base, nasopharyngeal, parapharyngeal, and laryngeal lesions. 4,9,13,19,22,[24][25][26]34,38 Advantages of TORS include superior 3D visualization, increased instrument access, precise and tremor-free 3-handed surgery, and elimination of external incisions, while limitations include the lack of bone-drilling equipment, relatively bulky instrumentation, and a steep initial learning curve. 22,24,25,40 TORS has been shown to be highly effective in obtaining a direct, illuminated surgical window into the nasopharynx, allowing for surgical management of nasopharyngeal carcinomas and performance of complete nasopharyngectomy.…”

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confidence: 99%

The combined endonasal and transoral approach for the management of skull base and nasopharyngeal pathology: a case series

Sreenath

Rawal

Zanation

2014

FOC

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The posterior skull base and the nasopharynx have historically represented technically difficult regions to approach surgically given their central anatomical locations. Through continued improvements in endoscopic instrumentation and technology, the expanded endonasal approach (EEA) has introduced a new array of surgical options in the management of pathology involving these anatomically complex areas. Similarly, the transoral robotic surgical (TORS) approach was introduced as a minimally invasive surgical option to approach tongue base, nasopharyngeal, parapharyngeal, and laryngeal lesions. Although both the EEA and the TORS approach have been extensively described as viable surgical options in managing nasopharyngeal and centrally located head and neck pathology, both endonasal and transoral techniques have inherent limitations. Given these limitations, several institutions have published feasibility studies with the combined EEA and TORS approaches for a variety of skull base and nasopharyngeal pathologies. In this article, the authors present their clinical experience with the combined endonasal and transoral approach through a case series presentation, and discuss advantages and limitations of this approach for surgical management of the middle and posterior skull base and nasopharynx. In addition, a presentation is included of a unique, simultaneous endonasal and transoral dissection of the nasopharynx through an innovative intraoperative setup.

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Transoral robotic surgery of the parapharyngeal space: A case series and systematic review

Abstract: TORS is a viable approach to resection of neoplasms of the PPS with minimal surgical morbidity. However, further long-term evaluation, especially for pleomorphic adenomas, is needed to define patient selection and the role of TORS for PPS salivary gland neoplasms.

Cited by 105 publications

References 26 publications

Surgical treatment of parapharyngeal space tumors: A report of 29 cases

Surgical treatment of parapharyngeal space tumors: A report of 29 cases

Transoral endoscopic head and neck surgery (eHNS) for minor salivary gland tumors of the oropharynx

The combined endonasal and transoral approach for the management of skull base and nasopharyngeal pathology: a case series

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