title: [The use of a flexible CO2-laser fiber in transoral robotic surgery (TORS)].
abstract: BACKGROUND
  Recently transoral robotic surgery has gained importance in the resection of head and neck tumors, especially in North America. The available resection tools are a fiber guided Tm:YAG-laser and a monopolar cautery, both causing wide coagulation and vaporization zones in healthy tissue. In order to improve the cutting properties we combined the system with a flexible CO2-laser fiber.
  
  
  METHODS
  6 patients suffering from T1 and T2 oropharyngeal carcinomas were treated between July 2012 and September 2012. In a prospective study we analyzed the feasibility, cutting properties, speed of resection as well as hemostasis and compared those with the monopolar cautery and the Tm:YAG laser which were recently examined in a series of 17 patients.
  
  
  RESULTS
  The application of a CO2-laser fiber with the da Vinci system was feasible and showed good cutting properties. Using a 15 watts energy level resulted in a favourable cutting depth and adequate hemostasis. In comparison to the monopolar cautery or the Tm:YAG laser, smaller coagulation and vaporization zones could be achieved.
  
  
  CONCLUSIONS
  Cutting properties of the da Vinci system can be improved by using a flexible CO2-laser fiber. Further prospective evaluations will follow.
authors.affiliation: Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Universitätsklinikum Essen, Essen.
authors.forename: S
authors.initials: S
authors.lastname: Mattheis
authors.affiliation: Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Universitätsklinikum Essen, Essen.
authors.forename: T K
authors.initials: TK
authors.lastname: Hoffmann
authors.affiliation: Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Universitätsklinikum Essen, Essen.
authors.forename: P J
authors.initials: PJ
authors.lastname: Schuler
authors.affiliation: Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Universitätsklinikum Essen, Essen.
authors.forename: N
authors.initials: N
authors.lastname: Dominas
authors.affiliation: Institut für Pathologie und Neuropatholgie, Universitätsklinikum Essen, Essen.
authors.forename: A
authors.initials: A
authors.lastname: Bankfalvi
authors.affiliation: Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Universitätsklinikum Essen, Essen.
authors.forename: S
authors.initials: S
authors.lastname: Lang
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D019723:Endoscopes; D004867:Equipment Design; D019544:Equipment Failure Analysis; D006488:Hemostasis, Surgical / Q000295:instrumentation; D006801:Humans; D053685:Laser Therapy / Q000295:instrumentation*; D054020:Lasers, Gas / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009959:Oropharyngeal Neoplasms / Q000473:pathology / Q000601:surgery*; D011446:Prospective Studies; D012371:Robotics / Q000295:instrumentation*; D013525:Surgical Instruments