Feasibility of the set-up for the different approaches in robotic head and neck surgery with the Versius Surgical System.

The Versius Surgical System is a next generation soft-tissue robot with instrument and endoscope arms split into individual modules. Despite its similarities with previous systems, the basic changes in the design raise concerns relating to the feasibility of the set-up for the different approaches in robotic head and neck surgery procedures. We used a complete unit with a surgeon's console and four modules on a training mannequin to depict the different configurations in the operating room. We tested transoral robotic surgery and the four basic configurations for the remote access to the neck: transoral/transvestibular, retroauricular, axillary and bilateral axillo-breast approaches. We obtained a high quality simulation for transoral robotic surgery, as well as for the usual remote access approaches, except for the axillary approach. We were able to obtain an optimal distribution of the modules around the surgical table and an adequate configuration of the joints allowing the instruments to reach their targets. The Versius Surgical System might be an alternative device for robotic procedures in head and neck surgery, although this needs to be proved in a clinical setting.

Pediatric turbinate radiofrequency ablation improves quality of life and rhinomanometric values. A prospective study.

OBJECTIVE: turbinate surgery in pediatric patients is gradually increasing in popularity amongst pediatric otolaryngologists. However, despite this, there is scarce information regarding this surgical procedure in children. The present research is designed with the aim of assessing changes in nasal resistance, nasal airflow and quality of life in pediatric patients undergoing turbinate radiofrequency ablation. METHODS: A prospective uncontrolled intervention clinical trial design was followed. Children between 4 and 15 years old undergoing turbinate radiodiofrequency ablation (TRA) were consecutively selected. Children were examined preoperatively and 1, 3, 6 and 12 months after turbinate surgery. Anterior active rhinomanometry with and without nasal decongestant and examination of the turbinates and adenoid size were carried out in each follow-up visit. The SN5 quality of live survey was answered by parents. RESULTS: 81 children were included, 28 with associated adenoidectomy. A significant improvement in quality of life was demonstrated since the first month after TRA. Regarding nasal resistance, there was an improvement 1 month after surgery, but it only reached statistical significance for the whole sample (p < 0.001)) and for the cohort of isolated turbinate surgery (p < 0.001) at 3 months, while the values for the cohort of children who underwent adenoidectomy reached significance at 6 months after surgery (p = 0.04). The difference in nasal resistance before and after decongestant was compared to the change in nasal resistance after surgery. It demonstrated a strong correlation with the change in nasal resistance at 1 month (R = 0.985; p < 0.001), 3 months (R = 0.995; p < 0.001), 6 months (R = 0.98; p < 0.001) and 12 months (R = 0.98; p < 0.001) after surgery. CONCLUSIONS: turbinate surgery in pediatric patients seems to be a safe procedure which objectively and subjectively improves the symptoms of children suffering from nasal obstruction.

Transoral robotic approach for laryngeal schwannoma.

BACKGROUND: The laryngeal schwannoma is a rare benign tumor of the larynx, most frequently found in the aryepiglottic fold, which can be rather bulky when diagnosed. METHODS: We present a primary transoral robotic surgery (TORS) for a laryngeal schwannoma and highlight the advantages of the robotic assistance. RESULTS: Thanks to the high-definition 3D dynamic vision and an improved freedom of movement, it is possible to accurately accomplish surgical tasks that previously were much more complex or even unfeasible through a minimally invasive approach, potentially minimizing the surgical damage. CONCLUSION: Robotic-assisted surgery eased excision, supporting that it can expand the indications for transoral approaches.

Transoral Robotic Surgery: Step-by-Step Radical Tonsillectomy.

Introduction. Transoral robotic surgery (TORS) radical tonsillectomy is an emerging minimally invasive surgical procedure for the treatment of cancer of the tonsil. The detailed surgical technique and claims for its reproducibility have been previously published. Case Presentation. We present a patient with a T2N2bM0 epidermoid carcinoma of the tonsil to illustrate step by step the surgical procedure for TORS radical tonsillectomy. Neck dissection and TORS were staged. No surgical reconstruction of the defect was required. No tracheostomy was necessary. The patient could eat without any feeding tube and was on full oral diet on the fifth postoperative day. Discussion. The transoral approach offers the benefits of minimally invasive surgery to patients with cancer of the tonsil. The excellent exposure and high precision provided by robotic instrumentation allow the surgeon to closely follow and accomplish the surgical steps, which is the best warranty for safety and effectiveness.

[Intervention of spiral ligament fibrocytes in the metabolic regulation of the inner ear]. / Intervención de los fibrocitos del ligamento espiral en la regulación metabólica del oído interno.

Maintenance of the K(+) gradient between endolymph and perilymph is essential for normal hearing and depends primarily on the activity of the stria vascularis. Abundant Na-K-ATPase in marginal strial cells provides a pumping mechanism for preserving the K(+) level of the endolymph and consequently, the endocochlear potential. Fibrocytes in the lateral wall of the cochlea supply K(+) to the strial pump, via gap junctions, by recycling back into the stria the ions that efflux from the scala media during auditory transduction. The lateral wall of the cochlea encloses five types of fibrocytes, differentiated by their location, structural features and content of enzymes mediating or energizing ion transport. The disruption of the gap junction bonds by connexin mutations and other pathologies leads to an interruption of K(+) recirculation pathways. The expression of cochlin and otoraplin, proteins that participate in structural or regulatory functions in the inner ear, suggests more diversity and complexity of the mesenchymal tissues than envisioned previously. The presence of otospiralin, a novel protein found in fibrocytes of spiral limbus, spiral ligament and subepithelial regions of the vestibule, represent a critical finding since that protein has been shown to be essential for the survival of the hair cells and supporting cells of the inner ear. A more profound knowledge and understanding of the function of inner ear fibrocytes will provide a new and promising aetiopathogenic approach to the treatment of inner ear disorders.

Intervención de los fibrocitos del ligamento espiral en la regulación metabólica del oído interno / Intervention of spiral ligament fibrocytes in the metabolic regulation of the inner ear

El mantenimiento de un gradiente de K+ entre la endolinfa y la perilinfa es imprescindible para la audición normal y depende inicialmente de la actividad de la estría vascular. La presencia de abundante Na-K-ATPasa en las células marginales de la estría vascular proporciona un mecanismo de bombeo al objeto de preservar la cantidad de K+ en la endolinfa y, consecuentemente, el potencial endococlear. Los fibrocitos de la pared lateral coclear suministran K+ a la estría, vía gap junctions, mediante la recirculación hacia la estría de los iones que fluyen desde la escala media durante la transducción auditiva. La pared lateral de la cóclea contiene cinco tipos de fibrocitos, que se diferencian según su localización, sus características estructurales y su contenido de enzimas que median o facilitan la energía para el transporte iónico. La rotura de las uniones como los puentes celulares por mutaciones de conexinas y otras condiciones patológicas conduce al bloqueo de las vías de recirculación de K+. La expresión de coclina y otorraplina, proteínas que intervienen en funciones estructurales o reguladoras del oído interno, indica una diversidad y una complejidad de los tejidos mesenquimales mayores que lo imaginado previamente. La presencia de otospiralina, una proteína novedosa encontrada en los fibrocitos del limbo espiral, el ligamento espiral y las regiones subepiteliales del vestíbulo, es un hallazgo muy importante, ya que dicha proteína se ha mostrado esencial para la supervivencia de las células ciliadas y las células de sostén del oído interno. Conocer y entender mejor la función de los fibrocitos proporcionará un nuevo y prometedor abordaje etiopatogénico para el tratamiento de las enfermedades del oído interno (AU)

Maintenance of the K+ gradient between endolymph and perilymph is essential for normal hearing and depends primarily on the activity of the stria vascularis. Abundant Na-K-ATPase in marginal strial cells provides a pumping mechanism for preserving the K+ level of the endolymph and consequently, the endocochlear potential. Fibrocytes in the lateral wall of the cochlea supply K+ to the strial pump, via gap junctions, by recycling back into the stria the ions that efflux from the scala media during auditory transduction. The lateral wall of the cochlea encloses five types of fibrocytes, differentiated by their location, structural features and content of enzymes mediating or energizing ion transport. The disruption of the gap junction bonds by connexin mutations and other pathologies leads to an interruption of K+ recirculation pathways. The expression of cochlin and otoraplin, proteins that participate in structural or regulatory functions in the inner ear, suggests more diversity and complexity of the mesenchymal tissues than envisioned previously. The presence of otospiralin, a novel protein found in fibrocytes of spiral limbus, spiral ligament and subepithelial regions of the vestibule, represent a critical finding since that protein has been shown to be essential for the survival of the hair cells and supporting cells of the innerear. Amore profound knowledge and understanding of the function of inner ear fibrocytes will provide a new and promising aetiopathogenic approach to the treatment of innerear disorders (AU)

[Ultra-structural study of the lateral portion of the auditory sensorial organ using a decalcification-free method]. / Estudio ultraestructural de la porción lateral del órgano sensorial auditivo mediante un método sin descalcificación.

OBJECTIVE: To explain the development of a new personal technique to study the spiral ligament and stria vascularis in Guinea pig cochleae by obtaining sample tissue without decalcification and to assess its validity for electron microscopy analysis. MATERIAL AND METHOD: Samples were taken from five female Guinea pigs weighing 200-250 g and were fixed in glutaraldehyde and paraformaldehyde for analysis of the spiral ligament and stria vascularis ultrastructure by transmission electron microscopy. RESULTS: All of the ultrastructure components in the spiral ligament and stria vascularis could be examined without the need for decalcification. CONCLUSIONS: Our method to obtain and analyze samples of cochlea side wall is valid, easy and faster.

Estudio ultraestructural de la porción lateral del órgano sensorial auditivo mediante un método sin descalcificación / Ultra-structural study of the lateral portion of the auditory sensorial organ using a decalcification-free method

Objetivo: Explicar el desarrollo de una técnica personal de estudio de la estría vascular y ligamento espiral de la cóclea en cobaya mediante la obtención de la muestra sin necesidad de descalcificación y valorar su validez para su análisis con microscopio electrónico. Material y método: Se obtuvieron muestras de 5 hembras de cobaya de 200-250 g que se fijaron con glutaraldehído y paraformaldehído, y se analizó la ultra estructura del ligamento espiral y la estría vascular obtenidos mediante microscopio electrónico de transmisión. Resultados: Se pudo observar todos los componentes ultraestructurales del ligamento espiral y la estría vascular sin necesidad de descalcificar. Conclusiones: Nuestro método de obtención de las muestras es una forma válida, sencilla y más rápida que otros métodos para la obtención y el estudio de la porción lateral de la cóclea (AU)

Objective: To explain the development of a new personal technique to study the spiral ligament and stria vascularis in Guinea pig cochleae by obtaining sample tissue without decalcification and to assess its validity for electron microscopy analysis. Material and method: Samples were taken from five female Guinea pigs weighing 200-250 g and were fixed in glutaraldehyde and paraformaldehyde for analysis of the spiral ligament and stria vascularis ultra structure by transmission electron microscopy. Results: All of the ultra structure components in the spiral ligament and stria vascularis could be examined without the need for decalcification. Conclusions: Our method to obtain and analyze samples of cochlea side wall is valid, easy and faster (AU)