TransOral endoscopic UltraSonic Surgery (TOUSS): a preliminary report of a novel robotless alternative to TORS

Fernández-Fernández, Mario M.; Montes-Jovellar, Lourdes; Parente Arias, Pablo Luis; Ortega del Alamo, Primitivo

doi:10.1007/s00405-014-3423-6

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TransOral endoscopic UltraSonic Surgery (TOUSS): a preliminary report of a novel robotless alternative to TORS

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Author(s): Mario M. Fernández-Fernández , Lourdes Montes-Jovellar , Pablo Luis Parente Arias , Primitivo Ortega del Alamo

Publication date (Electronic): 16 December 2014

Journal: European Archives of Oto-Rhino-Laryngology

Publisher: Springer Berlin Heidelberg

Keywords: Transoral surgery, Oropharyngeal carcinoma, Hypopharyngeal carcinoma, Supraglottic carcinoma, Robotic surgery, Thunderbeat

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Abstract

The objective of this study is to describe and evaluate the feasibility of TransOral UltraSonic Surgery (TOUSS), a new endoscopic alternative to transoral robotic surgery for approaching pharyngeal and laryngeal tumours based on ultrasonic scalpel as a resection tool. This is a prospective study on 11 consecutive patients with pharyngeal and supraglottic carcinomas between December 2013 and August 2014. All tumours were resected transorally with 35 cm ThunderbeatTM. Exposure was achieved using GyrusTM FK-retractor and Olympus ENDOEYE Flex 5 mm 2D/10 mm 3D deflecting tip video laparoscopes. We evaluated tumour staging, surgical margins, surgical time, blood transfusions, tracheostomy, enteral feeding, postoperative pain and hospital stay. The operating room setup and procedure are described. This series comprised seven early and four locally advanced carcinomas. The mean setup for TOUSS and resection time were 16 and 70.9 minutes. No major intraoperative complications were identified. The average time of nasogastric feeding tube dependence ( n = 9) was 13 days. Gastrostomy was performed in one patient. The average hospital stay was 14.3 days. Postoperative pain was satisfactory treated with nonsteroidal anti-inflammatory drugs. We have described TOUSS as a new feasible and intuitive procedure to approach endoscopically pharyngeal and supraglottic tumours, with good intraoperative conditions and functional outcomes.

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Most cited references 20

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Transoral robotic surgery (TORS) for base of tongue neoplasms.

Bert W O'Malley, Gregory S Weinstein, Wendy Snyder … (2006)

To develop a minimally invasive surgical technique for the treatment of base of tongue neoplasms using the optical and technical advantages of robotic surgical instrumentation. Ten experimental procedures including tongue base exposure and dissections were performed on three cadavers and two mongrel dogs. Transoral robotic surgery (TORS) was then performed on three human patients with tongue base cancers in a prospective human trial. Using the da Vinci Surgical Robot (Intuitive Surgical, Inc., Sunnyvale, CA), we performed a total of 10 base of tongue resections on edentulous and dentate cadavers as well as live mongrel dogs. In the cadaver models, exposure was evaluated using three different retractors, the Dingman, Crowe Davis, and FK retractors. The three human patients underwent TORS surgery of their tongue base cancers under an institutional review board approved prospective clinical trial. The ability to identify and preserve or resect key anatomic structures such as the glossopharyngeal, hypoglossal, and lingual nerves as well as techniques for identifying the lingual artery and achieving hemostasis were developed. The da Vinci Surgical Robot provided excellent visualization and enabled removal of the posterior one third to one half of the oral tongue in cadavers, dogs, and human patients. Among the three retractors evaluated, the FK retractor offered the greatest versatility and overall exposure for robotic instrument maneuverability. Complete resection to negative surgical margins with excellent hemostasis and no complications was achieved in the live patient surgeries. TORS provided excellent three-dimensional visualization and instrument access that allowed successful surgical resections from cadaver models to human patients. TORS is a novel and minimally invasive approach to tongue neoplasms that has significant advantages over classic open surgery or endoscopic transoral laser surgery.

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Transoral robotic surgery for oropharyngeal squamous cell carcinoma: a prospective study of feasibility and functional outcomes.

Jan L Kasperbauer, K Olsen, Sophie E. Moore (2009)

To investigate the feasibility of transoral robotic surgery as a method of surgical treatment of oropharyngeal squamous cell carcinoma. Prospective case study. Forty-five patients with previously untreated oropharyngeal squamous cell carcinoma underwent transoral robotic surgical removal of the tumor with or without neck dissection and with or without adjuvant therapy. Patients were observed and data were recorded on surgical time, blood loss, surgical complications, tracheostomy tube course, enteral feeding, and resumption of oral diet, speech outcomes, swallowing outcomes, and tumor recurrence. All 45 patients underwent complete transoral robotic surgical excision with simultaneous unilateral or bilateral neck dissection. Margins were negative for tumor. Mean operating time for tumor removal was 71.3 minutes for the last 35 cases. There were 15 stage T1 tumors, 18 T2 tumors, 3 T3 tumors, and 9 T4a tumors. Twenty-six patients had base of tongue primary tumors and 19 had tonsillar fossa tumors. Fourteen patients had a tracheostomy tube placed at surgery, and all patients had their tracheostomy tube removed (mean duration of use, 7.0 days). Twenty-two patients (48.9%) had a nasogastric feeding tube placed, and all patients had their feeding tube removed (mean duration of use, 12.5 days). Eight patients had percutaneous gastrostomy (PEG) tubes placed, and all eight eventually had their PEG tubes removed (mean duration of use, 140.3 days). Average hospital stay was 3.8 days. There were no major complications and no procedure was aborted because of an inability to remove the tumor. Transoral robotic surgery is a safe and efficacious method of surgical treatment of oropharyngeal neoplasms. Advantages of the technique include adequate ability to visualize and manipulate with two hands lesions in the base of tongue. Patients were able to retain or rapidly regain oropharyngeal function in the majority of cases.

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Transoral robotic surgery for advanced oropharyngeal carcinoma.

Erica G. Weinstein, Harry Quon, Lewis Cohen … (2010)

To determine the oncologic and functional outcomes in patients undergoing primary transoral robotic surgery followed by adjuvant therapy as indicated with a minimum of 18-month follow-up for advanced oropharyngeal carcinoma. Prospective single-center cohort study. Academic university health system and tertiary referral center. Forty-seven adults with newly diagnosed and previously untreated advanced oropharyngeal carcinoma. Transoral robotic surgery with staged neck dissection and adjuvant therapy as indicated. Margin status, recurrence, disease-specific and disease-free survival, gastrostomy tube dependence, and safety and efficacy end points. In the 47 patients enrolled with stages III and IV advanced oropharyngeal carcinoma, mean follow-up was 26.6 months. There was no intraoperative or postoperative mortality. Resection margins were positive in 1 patient (2%). At last follow-up, local recurrence was identified in 1 patient (2%), regional recurrence in 2 (4%), and distant recurrence in 4 (9%). Disease-specific survival was 98% (45 of 46 patients) at 1 year and 90% (27 of 30 patients) at 2 years. Based on pathologic risk stratification, 18 of 47 patients (38%) avoided chemotherapy, and 5 patients (11%) did not receive adjuvant radiotherapy and concurrent chemotherapy in their treatment regimen. At minimum follow-up of 1 year, only 1 patient required a gastrostomy tube. This novel transoral robotic surgery treatment regimen offers disease control, survival, and safety commensurate with standard treatments and an unexpected beneficial outcome of gastrostomy dependency rates that are markedly lower than those reported with standard nonsurgical therapies.

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Author and article information

Contributors

Mario M. Fernández-Fernández: mmarcos.fernandezf@salud.madrid.org

Journal

Journal ID (nlm-ta): Eur Arch Otorhinolaryngol

Journal ID (iso-abbrev): Eur Arch Otorhinolaryngol

Title: European Archives of Oto-Rhino-Laryngology

Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )

ISSN (Print): 0937-4477

ISSN (Electronic): 1434-4726

Publication date (Electronic): 16 December 2014

Publication date PMC-release: 16 December 2014

Publication date (Print): 2015

Volume: 272

Issue: 12

Pages: 3785-3791

Affiliations

[ ]Department of Otolaryngology, Hospital Universitario del Henares, Avda Marie Curie s/n, 28822 Coslada, Madrid Spain

[ ]Otolaryngology Head & Neck Surgery Department, MD Anderson International, c/Arturo Soria 270, 28033 Madrid, Spain

[ ]Department of Otolaryngology, Hospital Universitario de A Coruña, As Xubias s/n, 15006 A Coruña, Spain

[ ]Department of Otolaryngology, Hospital Universitario de Móstoles, c/Río Júcar s/n, 28935 Mostoles, Madrid Spain

Article

Publisher ID: 3423

DOI: 10.1007/s00405-014-3423-6

PMC ID: 4633440

PubMed ID: 25510983

SO-VID: 0cf35873-0cb6-474b-87f6-7d2aded35379

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.

History

Date received : 28 August 2014

Date accepted : 29 November 2014

Custom metadata

ScienceOpen disciplines: Otolaryngology

Keywords: transoral surgery,oropharyngeal carcinoma,hypopharyngeal carcinoma,supraglottic carcinoma,robotic surgery,thunderbeat

Data availability:

ScienceOpen disciplines: Otolaryngology

Keywords: transoral surgery, oropharyngeal carcinoma, hypopharyngeal carcinoma, supraglottic carcinoma, robotic surgery, thunderbeat

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