title: Transoral robotic surgery using the thulium:YAG laser: a prospective study.
abstract: OBJECTIVE
  To compare thulium:YAG laser-assisted transoral robotic surgery (TY:TORS) and conventional electrocautery-equipped TORS (EC:TORS) in patients undergoing transoral resection of upper aerodigestive tract malignant neoplasms.
  
  
  METHODS
  Prospective matched cohort study.
  
  
  METHODS
  Tertiary academic referral center.
  
  
  METHODS
  Fifteen patients undergoing TY:TORS were matched on the basis of tumor site, clinical T stage, sex, and age with 30 control subjects undergoing EC:TORS.
  
  
  METHODS
  The primary outcome was a comparison between the feasibility of TY:TORS compared with EC:TORS. The secondary outcome was a comparison between the safety and functional outcome of TY:TORS compared with EC:TORS in patients undergoing resection of upper aerodigestive tract malignant neoplasms.
  
  
  RESULTS
  All the tumors underwent complete excision with negative margins. Estimated blood loss was minimal (<150 mL) for 87% of TY:TORS patients (13 of 15) and 63% of EC:TORS controls (19 or 30). Intraoperative pharyngotomy was reported in 8% of TY:TORS patients (1 of 13) and 42% of EC:TORS controls (11 of 30) (P = .03). Postoperative pain was greater in EC:TORS compared with TY:TORS (P = .02). No statistically significant differences were noted in hemostasis, postoperative bleeding rates, or other complications.
  
  
  CONCLUSIONS
  Compared with EC:TORS, TY:TORS seems feasible and safe. In addition, TY:TORS resulted in fewer intraoperative pharyngotomies and less postoperative pain than did EC:TORS, which may be because of decreased collateral thermal damage, improved visualization, and finer cutting using the thulium laser.
authors.affiliation: Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic School of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Van Abel
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Moore
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Carlson
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Davidson
authors.forename: Joaquin J
authors.initials: JJ
authors.lastname: Garcia
authors.forename: Steven M
authors.initials: SM
authors.lastname: Olsen
authors.forename: Kerry D
authors.initials: KD
authors.lastname: Olsen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D004564:Electrocoagulation; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000295:instrumentation*; D053844:Lasers, Solid-State; D008297:Male; D008875:Middle Aged; D014066:Palatine Tonsil / Q000601:surgery*; D010610:Pharyngeal Neoplasms / Q000601:surgery*; D011446:Prospective Studies; D012371:Robotics; D013932:Thulium; D014062:Tongue Neoplasms / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D013932:Thulium