[THE USE OF ROBOTICS IN HEAD AND NECK SURGERY - THE EXPERIENCE OF RABIN MEDICAL CENTER].

INTRODUCTION: In recent years, minimally invasive surgeries have been undergoing a revolution with the development of robotic assisted surgery. Due to the anatomical region in which many operations are carried out, in small spaces through natural orifices in the body such as the mouth, the nose or the ear, as well as the esthetic discomfort caused by external scars in the head and neck, the use of robotic assisted surgery in the field of head and neck surgery is gaining momentum and is being implemented more and more in Israel and around the globe. Most of the operations currently performed in otolaryngology are carried out through the oral cavity or through distant and camouflaged skin cuts. In this article we will review the new applications and technologies in the field of surgical robotics in otolaryngology - head and neck surgeries, as well as summarize the experience of the Department of Otorhinolaryngology and Head and Neck Surgery at the Rabin Medical Center in robot assisted surgeries.

Post-laryngectomy voice rehabilitation: comparison of primary and secondary tracheoesophageal puncture.

BACKGROUND: Voice restoration following total laryngectomy is an important part of patients' rehabilitation and long-term quality of life. OBJECTIVES: To evaluate the long-term outcome of indwelling voice prostheses inserted during (primary procedure) or after (secondary procedure) total laryngectomy. METHODS: The study group included 90 patients who underwent total laryngectomy and tracheoesophageal puncture (TEP) with placement of voice prosthesis at a tertiary medical center during the period 1990-2008. Background, clinical and outcome data were collected by medical file review. Findings were compared between patients in whom TEP was performed as a primary or a secondary procedure. RESULTS: TEP was performed as a primary procedure in 64 patients and a secondary procedure in 26. Corresponding rates of satisfactory voice rehabilitation were 84.4% and 88.5% respectively. There was no association of voice quality with either receipt of adjuvant radiation/chemoradiation or patient age. The average lifetime of the voice prosthesis was 4.2 months for primary TEP and 9.06 months for secondary TEP (P= 0.025). CONCLUSIONS: Primary TEP provides almost immediate and satisfactory voice rehabilitation. However, it is associated with a significantly shorter average prosthesis lifetime than secondary TEP. Chemoradiotherapy and patient age do not affect voice quality with either procedure.

Measurement of inspiratory flow in children with acute asthma.

Dry-powder inhalers (DPIs) have been proposed for treatment of acute asthma. Different DPIs vary in their inspiratory resistance and have different recommended optimal peak inspiratory flows (PIFs). Reduced PIF during acute asthma may result in inadequate drug delivery to the lungs. Our aim was to measure the inspiratory flow in relation to inspiratory resistance during acute asthma in children presenting to the emergency room. School-age (range, 6-18 years) children were referred to the emergency room for acute asthma. PIF measurements were performed by In-Check Dial trade mark device with simulated airflow resistances equivalent to Turbuhaler, Diskus, and free flow. Percent change in PIF between remission and acute asthma (%Delta) was correlated with percent change in clinical score (CS) and percent change in spirometry in children <9 and >9 years old. Thirty-three children (21 males) participated. PIF with simulated Turbuhaler resistance was significantly lower than with simulated Diskus resistance in both acute and remission states (P < 0.0001). PIF with simulated Turbuhaler resistance increased from 62.1 +/- 15.3 (acute) to 74.4 +/- 16.5 l/min (remission, P < 0.0001), while with Diskus it rose from 72.6 +/- 20.5 to 91.1 +/- 18.9 l/min (P < 0.0001). Turbuhaler %Delta PIF correlated with %Delta FEV(1) (P = 0.01) and with %Delta CS (P = 0.0001). A lesser degree of correlation was observed while using Diskus resistance and in children above 9 years old. During acute asthmatic attacks, PIF is reduced; this reduction is particularly prominent in young children who use a high-resistance device. However, the PIF generated is generally within the values considered compatible with adequate lung deposition with both Diskus and Turbuhaler.