How to optimize laryngeal and hypopharyngeal exposure in transoral robotic surgery.
OBJECTIVE
The aim of this study was to present the various strategies adopted in our center to improve and overcome problems with exposure of the operative field in 48 patients who underwent TORS for the treatment of laryngeal and hypopharyngeal cancer.


METHODS
We present our operative and preoperative treatment protocols for patients undergoing TORS for laryngeal and hypopharyngeal cancer. In particular, we emphasize the role of preoperative exposure assessment and the usefulness of simple measures to overcome problems with exposure of the operative field.


RESULTS
In 12 patients (25%), we experienced difficult laryngeal-hypopharyngeal exposure. However the correct positioning of the robotic arms, the proper use of the laryngeal and tongue blade and some simple maneuvers, such as the anterior traction of the tongue and the partial epiglottectomy, ensured the feasibility of TORS with negative margins in all patients.


CONCLUSIONS
In TORS, the exposure of larynx and hypopharynx can be difficult, but the adoption of certain methods may make it possible in most patients. An accurate preoperative evaluation under general anesthesia is the primary strategy for reducing the number of cases terminated intraoperatively. Currently, TORS is not feasible in all patients, but in our opinion, reductions in the size of robotic equipment and development of new devices will extend the application of TORS to a larger number of patients.
Department of Otorhinolaryngology, Sapienza University of Rome, Italy.
Armando
A
De Virgilio
Young Min
YM
Park
Won Shik
WS
Kim
Seung Jae
SJ
Baek
Se-Heon
SH
Kim
D000368:Aged; D005260:Female; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000601:surgery*; D007822:Laryngeal Neoplasms / Q000601:surgery*; D008297:Male; D009125:Muscle Relaxants, Central / Q000627:therapeutic use; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D011300:Preoperative Care; D011446:Prospective Studies; D012371:Robotics; D013525:Surgical Instruments; D014140:Tracheotomy
D009125:Muscle Relaxants, Central