Transoral Fully Robotic Dissection of a Parapharyngeal Hemangioma.

Soft tissue robotics found its trigger for success in minimally invasive surgery. The minimization of the surgical damage is more obvious as the surgical alternative is more aggressive. In head and neck surgery, potential sequelae are both functional and cosmetic. Robotic instrumentation might allow for further development of the transoral approach to the deep regions of the face.The authors present an uneventful, fully robotic, transoral surgical excision of a parapharyngeal hemangioma. The authors discuss management alternatives, surgical risks, and safety measures. The medial approach is the natural choice, provided it is safe and technically feasible. Transoral robotic surgery could be a reasonable minimally invasive approach for selected parapharyngeal tumors.

Descending mediastinitis with mediastinal abscess after supracricoid partial laryngectomy.

We document a rare and not-yet-reported condition after supracricoid partial laryngectomy: the development of descending mediastinitis with mediastinal abscess. We present a case in which early diagnosis and team management allowed for a successful outcome. The pathophysiology of this severe complication, as well as its diagnosis, management, and prevention, is discussed, together with a review of the medical scientific literature.

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.

Frontolateral vertical partial laryngectomy without tracheotomy for invasive squamous cell carcinoma of the true vocal cord: a 25-year experience.

On the basis of an inception cohort of 270 patients with a previously untreated invasive squamous cell carcinoma of the true vocal cord (232 T N0M0, 35 T2N0M0, and 3 T3N0M0) and a minimum of 3 years of follow-up, the authors analyze the oncological and functional outcomes following frontolateral vertical partial laryngectomy without tracheotomy. The 5-year Kaplan-Meier actuarial survival estimate ranged from 83.1% for T1 tumors to 67.2% for T2 tumors (p = .005). On univariate analysis, a significant statistical relationship was noted between reduced survival and the following variables: increased age, increased Charlson comorbidity index score over grade 0, increased tobacco intake, increased alcohol intake, increased T stage, local failure, nodal failure, and development of a metachronous second primary cancer. The hospital mortality rate was 0.4%. A significant postoperative surgical complication was noted in 49 patients (18.1%). The predominant significant surgical complication was wound infection (19 patients; 7%), followed by seroma and major subcutaneous emphysema. No significant statistical relationship was noted in a comparison of each, significant postoperative complication (including postoperative death) with the variables under analysis. The incidence of secondary tracheotomy was 0.4%. The incidence of completion laryngectomy due to functional problems was 0%. The 5-year Kaplan-Meier actuarial local control estimate was 91% for T1 tumors and 68.7% for T2 tumors (p <.0001). Within the T1 tumors, the 5-year Kaplan-Meier actuarial local control estimate ranged from 96.2% for tumors without anterior commissure involvement to 74.7% for tumors with anterior commissure involvement (p = .0002). On univariate analysis, a significant statistical relationship was noted between an increase in local recurrence and the following variables: increased T stage, anterior commissure involvement, and pathological margin involvement. The overall disease control rate and laryngeal preservation rate were 92.9% and 93.3%, respectively.

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.

Diagnostic capacity of non-echo planar diffusion-weighted MRI in the detection of primary and recurrent cholesteatoma.

INTRODUCTION AND AIMS: the aim of this study was to determine the certainty of non-echo-planar imaging diffusion-weighted magnetic resonance imaging (non-EPI DW MRI) in the diagnosis of primary and recurrent cholesteatoma in patients with clinical suspicion of cholesteatoma, assessing the sensitivity and specificity of the test in both groups. METHODS: Seventy-five patients with clinical suspicion of cholesteatoma were included in our study. Forty-eight cases had primary suspicion of cholesteatoma and 27 cases had recurrent suspicion of cholesteatoma. All patients received non-EPI DW MRI tests before surgery, and radiological and surgical findings were compared. RESULTS: Sensitivity, specificity and the positive and negative predictive value for primary diagnosis of cholesteatoma group were 91.2%, 50%, 81.6% and 70%, respectively. For the recurrent cholesteatoma group these results were 100%, 66.7%, 90.9% and 100%, respectively. CONCLUSION: Non-echo-planar imaging diffusion-weighted magnetic resonance imaging is a high sensitivity imaging test for detecting cholesteatoma, for both primary diagnosis and for recurrent cases.

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.

Management of oropharyngeal Dysphagia in laryngeal and hypopharyngeal cancer.

On considering a function-preserving treatment for laryngeal and hypopharyngeal cancer, swallowing is a capital issue. For most of the patients, achieving an effective and safe deglutition will mark the difference between a functional and a dysfunctional outcome. We present an overview of the management of dysphagia in head and neck cancer patients. A brief review on the normal physiology of swallowing is mandatory to analyze next the impact of head and neck cancer and its treatment on the anatomic and functional foundations of deglutition. The approach proposed underlines two leading principles: a transversal one, that is, the multidisciplinary approach, as clinical aspects to be managed in the oncologic patient with oropharyngeal dysphagia are diverse, and a longitudinal one; that is, the concern for preserving a functional swallow permeates the whole process of the diagnosis and treatment, with interventions required at multiple levels. We further discuss the clinical reports of two patients who underwent a supracricoid laryngectomy, a function-preserving surgical technique that particularly disturbs the laryngeal mechanics, and in which swallowing rehabilitation dramatically conditions the functional results.

Ajustar el enfoque en cirugía robótica transoral / Adjusting the focus of transoral robotic surgery

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Capacidad diagnóstica de la resonancia magnética con técnica de difusión no eco-planar en la detección de colesteatomas primarios y recurrentes / Diagnostic capacity of non-echo planar diffusion-weighted MRI in the detection of primary and recurrent cholesteatoma

Introducción y objetivos: El objetivo de este estudio es determinar la fiabilidad de la resonancia magnética con técnica de difusión no eco-planar en el diagnóstico de pacientes con sospecha clínica de colesteatoma primario y recurrente, evaluando la sensibilidad y especificidad de la prueba en ambos grupos. Métodos: Setenta y cinco pacientes con sospecha clínica de colesteatoma fueron incluidos en el estudio. Cuarenta y ocho pacientes presentaban sospecha clínica de colesteatoma primario y 27 pacientes presentaban sospecha clínica de colesteatoma recurrente. En todos los pacientes se realizó una resonancia magnética con técnica de difusión no eco-planar previa a la cirugía y se compararon los resultados radiológicos con los resultados quirúrgicos obtenidos. Resultados: La sensibilidad, la especificidad, el valor predictivo positivo y el negativo en el grupo de colesteatoma primario fue del 91,2, el 50, el 81,6 y el 70%, respectivamente, y en el grupo de colesteatoma recurrente fue del 100, el 66,7, el 90,9 y el 100, respectivamente. Conclusión: La resonancia magnética con técnica de difusión no eco-planar es una prueba altamente sensible en el diagnóstico del colesteatoma tanto en pacientes con colesteatoma primario como en recurrencias (AU)

Introduction and aims: the aim of this study was to determine the certainty of non-echo-planar imaging diffusion-weighted magnetic resonance imaging (non-EPI DW MRI) in the diagnosis of primary and recurrent cholesteatoma in patients with clinical suspicion of cholesteatoma, assessing the sensitivity and specificity of the test in both groups. Methods: Seventy-five patients with clinical suspicion of cholesteatoma were included in our study. Forty-eight cases had primary suspicion of cholesteatoma and 27 cases had recurrent suspicion of cholesteatoma. All patients received non-EPI DW MRI tests before surgery, and radiological and surgical findings were compared. Results: Sensitivity, specificity and the positive and negative predictive value for primary diagnosis of cholesteatoma group were 91.2%, 50%, 81.6% and 70%, respectively. For the recurrent cholesteatoma group these results were 100%, 66.7%, 90.9% and 100%, respectively. Conclusion: Non-echo-planar imaging diffusion-weighted magnetic resonance imaging is a high sensitivity imaging test for detecting cholesteatoma, for both primary diagnosis and for recurrent cases (AU)