Transoral robotic surgery (TORS) in laryngeal and hypopharyngeal cancer.
OBJECTIVE
The current trend in managing laryngeal and hypopharyngeal cancer is to perform organ preservation therapy, which improves quality of life and decreases treatment-related morbidity. Transoral robotic surgery (TORS) can overcome the limit of "line of sight" often met in classic transoral procedure. We utilized a robotic surgical system to evaluate the feasibility and oncologic safety of transoral partial pharyngectomy and laryngectomy.


METHODS
TORS was performed by using a "da Vinci surgical robot" (Intuitive Surgical, Inc., Sunnyvale, CA). An FK retractor (Gyrus Medical Inc., Maple Grove, MN) was used to expose the cancerous lesion transorally, and an endoscopic arm was introduced through the oral cavity with two instrument arms placed 30 degrees apart from the endoscopic arm. We performed TORS on 1 patient with pyriform sinus carcinoma and 4 patients with glottic carcinoma as a prospective human trial.


RESULTS
Average surgical time measured was 39 minutes, including an average of 25 minutes used for locating the robotic surgical system in place and exposing the lesion. TORS can provide a magnified three-dimensional view and overcome the limitation resulting from the "line of sight" that hinders the classic transoral procedure. All surgical resection margins were free of carcinoma. There were no perioperative complications, and also, no mortality due to the surgical procedure.


CONCLUSIONS
This study demonstrates that the application of TORS for partial pharyngectomy and partial laryngectomy is technically feasible and safe.
Park
Young Min
YM
Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea.
Lee
Woo Jung
WJ
Lee
Jeong Gwon
JG
Lee
Won Sang
WS
Choi
Eun Chang
EC
Chung
Sa Myung
SM
Kim
Se-Heon
SH
D005240:Feasibility Studies; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000601:surgery*; D007822:Laryngeal Neoplasms / Q000601:surgery*; D007825:Laryngectomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009055:Mouth; D018579:Patient Selection; D010611:Pharyngectomy / Q000379:methods*; D011446:Prospective Studies; D012371:Robotics; D016896:Treatment Outcome