Robotic resection of benign neck masses via a retroauricular approach.

OBJECTIVES: The purpose of this study was to analyze the feasibility and safety of robotic resection of benign upper neck masses through a modified facelift approach. PATIENTS AND METHODS: Between November 2010 and February 2012, 9 patients were enrolled in this prospective study. Six patients received a robotic submandibular gland resection via a retroauricular approach. Two patients received robotic resection of the second branchial cleft cyst. One patient received robotic operation for the removal of lymphadenopathy, which occurred in the submental area. RESULTS: Robotic resection of a benign upper neck mass was successfully performed through a retroauricular approach in all patients. The average robotic system docking times and robotic operation times were 8.5 minutes and 62.4 minutes, respectively. All patients were extremely satisfied with their cosmetic results after the operation. There were no cases of nerve palsy in the marginal mandibular branch of the facial nerve, the lingual nerve, the hypoglossal nerve, or the spinal accessory nerve. No patient required blood transfusion in response to significant bleeding or was converted to open surgery. Mean blood loss was minimal (6.6 mL). The average period of follow-up for the patients was 12.7 months. All patients have maintained disease-free status. CONCLUSIONS: Robotic resection of a benign upper neck mass via a retroauricular approach is technically feasible and results in better cosmetic outcomes than the conventional transcervical approach. This new surgical method is safe and effective for benign upper neck masses that require surgical removal.

Comparison study of transoral robotic surgery and radical open surgery for hypopharyngeal cancer.

CONCLUSIONS: The oncologic outcome of transoral robotic surgery (TORS) was comparable to radical open surgery. The TORS group showed a better functional recovery and quality of life (QOL) than the radical surgery group. Therefore, TORS was a valid treatment option as a minimally invasive surgery for selected patients with hypopharyngeal cancer. OBJECTIVES: To affirm rapid functional recovery and improved QOL of patients who underwent TORS, which is a minimally invasive surgical technique. METHODS: Between April 2008 and November 2011, 56 patients were enrolled in the study. During the study period, 30 patients underwent TORS and 26 patients underwent radical open surgery. RESULTS: In the TORS and radical surgery groups, the 3-year overall survival rate was 85% and 78%, respectively, and disease-free survival was 81% and 76%, respectively. Significant differences were not observed in the overall survival and disease-free survival rates. As regards postoperative functional recovery, the TORS group showed statistically better results for decannulation, swallowing, and hospitalization compared with the radical surgery group. On the University of Washington (UW)-QOL, the TORS group showed better results than the radical open surgery group in the domains of pain, activity, recreation, swallowing, speech, anxiety, and health-related QOL.

Parapharyngeal space surgery via a transoral approach using a robotic surgical system: transoral robotic surgery.

OBJECTIVE: In transoral robotic surgery (TORS), if an endoscopic arm equipped with two integrated cameras is placed close to a lesion, a three-dimensionally magnified view of the operative field can be obtained. More important is that the operation can be performed precisely and bimanually using two instrument arms that can move freely within a limited working space. We performed TORS to treat several diseases that occur in the parapharyngeal space (PPS) and subsequently analyzed the treatment outcomes to confirm the validity of this procedure. PATIENTS AND METHODS: Between February 2009 and February 2012, 11 patients who required surgical treatment for the removal of a parapharyngeal lesion were enrolled in this prospective study. Nine patients received TORS for parapharyngeal tumor resection, and 2 patients with stylohyoid syndrome underwent TORS for resection of an elongated styloid process. The average age of the patients included in this study was 42 years. Five patients were male, and 6 patients were female. RESULTS: TORS was successfully performed in all 11 patients. The average robotic system docking and operation times were 9.9 minutes (range, 5-24 minutes) and 54.2 minutes (range, 26-150 minutes), respectively. Patients were able to swallow normally the day after the operation. The average blood loss during the robotic operation was minimal (11.8 mL). The average hospital stay was 2.6 days. There were no significant complications in the perioperative or postoperative period. All patients were extremely satisfied with their cosmetic outcomes. CONCLUSIONS: PPS surgery via a transoral approach using a robotic surgical system is technically feasible and secures a better cosmetic outcome than the transcervical, transparotid, or transmandibular approach. This new surgical method is safe and effective for benign diseases of the PPS.

Endoscopic axillo-breast approach for benign neck mass excision.

OBJECTIVES/HYPOTHESIS: Benign neck masses are usually found in younger patients, who are more likely to be concerned about postoperative scars. Until recently, a direct approach through a transcervical incision along the mass has been accepted as a standard surgical procedure for the benign neck mass. However, this conventional transcervical approach leaves a visible scar on the neck, regardless of the size of the incision. We assumed that an endoscopic gasless axillo-breast (A-B) approach might be a good alternative method for excision of benign neck masses. The aim of this study was to determine the safety and feasibility of a gasless A-B approach for the excision of benign neck masses by comparing it to the conventional open approach. STUDY DESIGN: Case series. METHODS: We prospectively compared the outcomes of endoscopic removal of benign neck lesions with the outcomes of conventional open surgery. RESULTS: Most patients in the endoscopy group were women, and the mean age was younger than in the open group. Although operative time was longer and amount of drainage was larger in the endoscopy group, there was no statistically significant difference in duration of drainage, hospitalization period, complication rate, and pain score. Endoscopically treated patients were more satisfied with the cosmetic outcome of the surgery than patients in the conventional open group. CONCLUSIONS: Endoscopic excision via an A-B approach without gas insufflation could be a good substitute for conventional transcervical excision in selected cases of benign neck lesion.

Functional and molecular expression of epithelial sodium channels in cultured human endolymphatic sac epithelial cells.

HYPOTHESIS: Epithelial sodium channels are expressed in cultured human endolymphatic sac (ES) epithelial (HESE) cells and epithelial sodium channel (ENaC) expression is suppressed by interleukin 1beta. BACKGROUND: The ES is part of the membranous labyrinth in the inner ear that plays an important role in maintaining homeostasis of the endolymphatic fluid system. However, the exact mechanism of fluid volume regulation is not yet known. METHODS: The ES specimens were harvested during acoustic neuroma surgery (n = 13) using the translabyrinthine approach and were subcultured with high-epidermal growth factor (25 ng/mL) media. RESULTS: The serially passaged HESE cells differentiated into a monolayer of confluent cells and some of the cultured cells had features of mitochondria-rich cells. Reverse transcription-polymerase chain reaction revealed that ENaC subunits are expressed in the cultured HESE cells. We also confirmed the presence of an ENaC-dependent short-circuit current in the cultured HESE cells. Interestingly, ENaC mRNA expression and ENaC-dependent current decreased after treatment with interleukin 1beta (10 nmol/L for 24 h). CONCLUSION: These findings suggest that ENaC plays an important role in fluid absorption in the human ES and that its function may be altered during inflammatory conditions.

Activation of epithelial sodium channel in human middle ear epithelial cells by dexamethasone.

The middle ear epithelium functions to maintain a fluid-free middle ear cavity. Dysfunction of the middle ear epithelial ion and fluid transport is implicated in the pathogenesis of fluid collection in the middle ear cavity, characteristic of otitis media with effusion. The efficacy of steroid therapy for the treatment of otitis media with effusion remains controversial, and postulated modulation of transepithelial transport function in middle ear epithelia has yet to be demonstrated. The effect of dexamethasone on Na(+) transport and fluid absorption capacity was investigated in cultured normal human middle ear epithelial (NHMEE) cells. Dexamethasone produced a significant increase in amiloride-sensitive short-circuit current (Isc). Dexamethasone significantly increased expression levels of mRNAs and proteins of Epithelial Sodium Channel (ENaC)-alpha and -beta subunits. In addition, the ENaC-dependent fluid absorption was significantly increased after dexamethasone treatment. In summary, we have shown that dexamethasone stimulates ENaC activity and ENaC-dependent fluid absorption in NHMEE cells. These findings suggest glucocorticosteroids may be beneficial in treatment of otitis media with effusion by stimulating Na(+) transport and fluid clearance in the middle ear epithelia.