Transoral Robotic Surgery with Laser for Head and Neck Cancers: A Feasibility Study

Benazzo, Marco; Canzi, Pietro; Occhini, Antonio

doi:10.1159/000337092

Cited by 15 publications

(9 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…One of the main fields of application of robotic surgery in head and neck pathology is TORS [1,11]. The great oncological and functional results obtained by TORS in the treatment of early pharyngolaryngeal cancers have strongly encouraged its spread, providing numerous confirmations of feasibility [7,12,13], but also highlighting its limitations and the need for new tools to achieve even better outcomes [14].…”

Section: Discussionmentioning

confidence: 99%

“…Diode thulium: yttrium aluminium garnet (YAG) laser (TY) has been the first to be approved to be coupled with robotic technology [4]. We previously explored the feasibility of flexible thulium laser coupling with a novel robotic introducer for the treatment upper aerodigestive cancers [7]. More recently, flexible carbon dioxide (CO 2 ) laser fibres have been developed to be suited for TORS, in order to reduce the severity of thermal damage.…”

Section: Introductionmentioning

confidence: 99%

“…All patients were preoperatively counselled about the conventional alternatives and signed informed consent was obtained. Surgical robotic set-up was predisposed as previously reported [7], and included: The cutting tool (TY-laser, CO 2 -laser or EC) was handled in the left or right robotic arm relative to patient anatomy, independently of the surgeon handedness.…”

mentioning

confidence: 99%

See 2 more Smart Citations

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

Benazzo

Canzi

Mauramati

et al. 2019

JCM

Self Cite

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

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

Benazzo

Canzi

Mauramati

et al. 2019

JCM

Self Cite

View full text Add to dashboard Cite

show abstract

“…Feasibility has since been demonstrated in TORS patients. 27 The presence of an aiming beam is thought to be a major advantage compared to CO 2 LASER. The fiber needs to be very close to target tissue, however, and burns frequently, requiring refreshing of the cutting tip.…”

Section: Lasersmentioning

confidence: 99%

<p>Novel Energy Devices in Head and Neck Robotic Surgery – A Narrative Review</p>

Ross¹,

Tolley²,

Awad³

2020

RSRR

View full text Add to dashboard Cite

The advent of trans-oral robotic surgery (TORS) has facilitated removal of tumors previously deemed unresectable, by providing access to the deep structures of the head and neck. Despite this, the wider dissemination of TORS has been restricted due to issues with line of access, as the da Vinci robot was never designed with head and neck surgery in mind. Flexible instruments and novel energy delivery devices offer great potential in overcoming some of the existing challenges surrounding TORS. This review aimed to summarize the existing literature surrounding energy delivery in TORS and highlight areas of future innovation. MEDLINE was searched for studies relating to energy delivery in TORS in November 2019. The existing literature surrounding monopolar and bipolar electrocautery, LASER (CO 2 , Tm:YAG and blue LASER), Ligasure and Harmonic was reviewed. Additionally, the latest iteration of the da Vinci; the SP, and the FLEX robot were evaluated as novel methods of energy delivery in TORS. Overall, these novel energy devices and robotic systems are predicted to further improve energy delivery to the head and neck. The use of flexible LASER in particular is well substantiated in the literature. This has the potential to achieve treatment de-escalation, based on the excellent outcomes demonstrated for disease-free margins and post-operative morbidity.

show abstract

“…adjacent tissue damage, and excellent tissue hemostasis. [19][20][21][22] The EndoWrist ® and angled telescope of the da Vinci surgical robot allow delivery of laser to areas previously not able to be reached by traditional delivery methods like transoral laser microscopic surgery.…”

Section: Application Of the Da Vinci Surgical Robot In Upper Aerodigementioning

confidence: 99%

Transoral robotic surgery: development and challenges

Tsang

2015

RSRR

View full text Add to dashboard Cite

The da Vinci Surgical robot has been marketed since 1999; it was originally designed for aiding complex laparoscopic operations and cardiac operations. By the mid-2000s, otolaryngologists had been attempting to deploy the surgical robot for endoscopic minimally invasive operations in the upper aerodigestive tract. The development went through a mannequin model, canine model, and cadaver model and finally cumulated to human Phase I trial. The operation was dubbed transoral robotic surgery (TORS). Subsequently, multicenter trials in the United States had proved the safety and oncological efficacy of using the surgical robot for resection of early cancers in the upper aerodigestive tract. In 2009, the US Food and Drug Administration granted license for the da Vinci surgical robot to be used for resection of benign tumors and early cancers in the oropharynx, larynx, and hypopharynx. TORS has also developed for surgery in the anterior skull base and nasopharynx, as well as in setting of flaps for reconstruction in the upper aerodigestive tract. This article will review the development of TORS, the current limitations, and future developments.

show abstract

Transoral Robotic Surgery with Laser for Head and Neck Cancers: A Feasibility Study

Cited by 15 publications

References 43 publications

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

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

<p>Novel Energy Devices in Head and Neck Robotic Surgery – A Narrative Review</p>

Transoral robotic surgery: development and challenges

Contact Info

Product

Resources

About