Transoral Robotic Surgery: Step-by-Step Radical Tonsillectomy

Granell, José Campos; Méndez-Benegassi, Iván; Millas, Teresa; Garrido, Laura; Gutiérrez-Fonseca, Raimundo

doi:10.1155/2014/497528

Cited by 8 publications

(16 citation statements)

References 9 publications

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“…Of these articles, 5 were prospective studies, 13 , 16 , 21 , 22 and 14 were retrospective studies ( Tables 2 and 3 ). 6 , 12 , 14 , 15 , 17 - 20 , 23 , 25 - 29 There was significant heterogeneity among study designs and recorded outcomes, meaning that a formal meta-analysis was not possible.…”

Section: Resultsmentioning

confidence: 99%

Neck Dissection Timing in Transoral Robotic or Laser Microsurgery in Oropharyngeal Cancer: A Systematic Review

Ramchandani

Brunet²,

Skalidi³

et al. 2022

OTO Open

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Objective This review assesses the effect on intra- and postoperative patient outcomes of the timing of neck dissection in relation to transoral surgery. Outcome measures include postoperative bleeding, intra- and postoperative fistula formation, and disease-specific and overall survival. Data Sources A search was conducted across the MEDLINE, Embase, US National Library of Medicine, and Cochrane databases with search terms in July 2021. Review Methods Articles that conformed with specified inclusion criteria were included. Included articles were scanned for bias with the ROBINS-I tool. Results Nineteen articles were selected for qualitative analysis, including 546 patients who had neck dissection in conjunction with transoral robotic surgery/transoral laser microsurgery (TORS/TLM). Seventy-one (18%) patients had neck dissection prior to TORS/TLM, 39 (10%) had neck dissection performed after TORS/TLM, and 281 (72%) had concurrent procedures. In patients with neck dissection before TORS/TLM, 3% experienced major postoperative bleeding, and fistula rates were 0%. In the cohort with neck dissection after TORS/TLM, 3% experienced minor postoperative hemorrhage, and 8% had intraoperative fistulae. In the concurrent cohort of patients, 1% had major postoperative bleeds and 0.3% had minor bleeds, while 4% developed intraoperative fistulas and 0.3% developed postoperative fistulas. Conclusion Current evidence indicated that there appears to be no correlation between timing of neck dissection and complications. This systematic review found insufficient data to comment on whether the timing of neck dissection in relation to TORS/TLM affects the outcomes of patients.

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Section: Resultsmentioning

confidence: 99%

Neck Dissection Timing in Transoral Robotic or Laser Microsurgery in Oropharyngeal Cancer: A Systematic Review

Ramchandani

Brunet²,

Skalidi³

et al. 2022

OTO Open

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“…The advancement of TORS has offered a minimally invasive approach to en bloc resection of tonsillar malignancies. This surgical technique removes the palatine tonsil lymphoid tissue with the surrounding SPC muscle envelope, while including a variable amount of the soft palate and base of tongue [1, 12]. A margin beyond the SPC muscle is limited by the parapharyngeal fat that does not offer a valuable barrier to cancer spread and contains critical neurovascular structures, including the carotid artery.…”

Section: Discussionmentioning

confidence: 99%

“…Six adult fresh cadaveric specimens were provided by the Maryland State Anatomy Board. Transoral radical tonsillectomies were performed in each cadaver yielding radical tonsillectomy specimens in accordance with a previously described transoral approach [12]. The procedure is outlined briefly as follows.…”

Section: Methodsmentioning

confidence: 99%

Radical Tonsillectomy and Superior Pharyngeal Constrictor Anatomy: A Cadaveric and Oncologic Specimen Assessment

Amin

Kallen

Hatten

2020

ORL

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Introduction: The rise in primary surgical management of oropharyngeal squamous cell carcinoma has led to varying interpretations of the histopathologic evaluation following a radical tonsillectomy. The oncologic margin may be significantly influenced by the morphologic relations and anatomic dimensions of the palatine tonsil and superior pharyngeal constrictor (SPC) muscle. Objective: The aim of this study was to characterize the gross and histologic anatomic features of the palatine tonsil and SPC muscle following an en bloc radical tonsillectomy. Methods: Radical tonsillectomy specimens were collected from cadaveric and oncologic subjects. Specimens were processed using standard histopathologic techniques and were analyzed by a board-certified head and neck pathologist. The thickness of the SPC muscle and relationship to the tonsillar carcinoma were assessed. Results: Six cadaveric and 10 oncologic specimens were analyzed. The mean minimum SPC width for all cadaveric specimens was 1.02 ± 0.50 mm. The mean minimum width for oncologic specimens was 0.76 ± 0.46 mm. The mean distance from tonsil carcinoma to the lateral specimen margin was 1.79 ± 1.39 mm. Conclusion: Due to the limited width of the SPC muscle, a margin in excess of 2 mm may not be attainable in a transoral radical tonsillectomy. Margin status may be ideally determined by the integrity of the SPC muscle in future oncologic studies, rather than an adequate distance measurement.

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“…However, those flaps, particularly the pharyngeal flap or primary approximation of the pharyngeal mucosa, may increase the risk of velopharyngeal insufficiency because of cicatricial retraction. Thus, flaps are not very often harvested for reconstruction after radical tonsillectomy and the wound is left open or partially open for healing by secondary intention . Risk of 4% of scar band between the tonsillar fossa and soft palate is reported in literature after radical tonsillectomy…”

Section: Introductionmentioning

confidence: 99%