title: Successful application of transoral robotic surgery in failures of traditional transoral laser microsurgery: critical considerations.
abstract: OBJECTIVE
  To assess the role of transoral robotic surgery (TORS) in managing failures of conventional transoral laser microsurgery (TLM) in cases with difficult laryngeal exposure.
  
  
  METHODS
  Retrospective analysis of 3 patients with difficult laryngeal exposure treated with TORS. All 3 cases failed to be managed by conventional TLM after repeated attempts by experienced surgeons. In 2 cases, the initial disease was laryngeal cancer treated by a cricohyoidoepiglottopexy, with an obstructing residual epiglottis. The last case was a bilateral Reinke disease submitted to repeated TLM procedures, producing multiple supraglottic and glottic scars. In all cases, the difficult exposure was produced by a combination of concurrent elements including insufficient mouth opening, short and stiff neck, macroglossia and high-positioned larynx.
  
  
  RESULTS
  Two patients were exposed by means of a Davis Meyer mouth gag. The other patient was managed by a Feyh-Kastenbauer device. The key of the success was the possibility to work 'around the corner' (30° angle view) where straight alignment of the larynx was impossible.
  
  
  CONCLUSIONS
  Where possible, a TORS approach should be considered complementary to TLM in cases of very difficult or even impossible conventional transoral laryngoscopic approach.
authors.affiliation: Oral Surgery Unit, Otolaryngology - Head and Neck Surgery Division, Department of Special Surgery, G.B. Morgagni L. Pierantoni Hospital, Forlì, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Vicini
authors.forename: Carlo Antonio
authors.initials: CA
authors.lastname: Leone
authors.forename: Filippo
authors.initials: F
authors.lastname: Montevecchi
authors.forename: Elisa
authors.initials: E
authors.lastname: Dinelli
authors.forename: Veronica
authors.initials: V
authors.lastname: Seccia
authors.forename: Iacopo
authors.initials: I
authors.lastname: Dallan
mesh_terms: D000368:Aged; D001193:Arytenoid Cartilage / Q000601:surgery; D004417:Dyspnea / Q000453:epidemiology; D004825:Epiglottis / Q000601:surgery; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000453:epidemiology / Q000601:surgery; D007828:Laryngoscopy; D053685:Laser Therapy / Q000379:methods*; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D012189:Retrospective Studies; D012371:Robotics / Q000379:methods*; D014059:Tongue / Q000601:surgery; D017211:Treatment Failure