title: TransOral endoscopic UltraSonic Surgery (TOUSS): a preliminary report of a novel robotless alternative to TORS.
abstract: The objective of this study is to describe and evaluate the feasibility of TransOral UltraSonic Surgery (TOUSS), a new endoscopic alternative to transoral robotic surgery for approaching pharyngeal and laryngeal tumours based on ultrasonic scalpel as a resection tool. This is a prospective study on 11 consecutive patients with pharyngeal and supraglottic carcinomas between December 2013 and August 2014. All tumours were resected transorally with 35 cm ThunderbeatTM. Exposure was achieved using GyrusTM FK-retractor and Olympus ENDOEYE Flex 5 mm 2D/10 mm 3D deflecting tip video laparoscopes. We evaluated tumour staging, surgical margins, surgical time, blood transfusions, tracheostomy, enteral feeding, postoperative pain and hospital stay. The operating room setup and procedure are described. This series comprised seven early and four locally advanced carcinomas. The mean setup for TOUSS and resection time were 16 and 70.9 minutes. No major intraoperative complications were identified. The average time of nasogastric feeding tube dependence (n = 9) was 13 days. Gastrostomy was performed in one patient. The average hospital stay was 14.3 days. Postoperative pain was satisfactory treated with nonsteroidal anti-inflammatory drugs. We have described TOUSS as a new feasible and intuitive procedure to approach endoscopically pharyngeal and supraglottic tumours, with good intraoperative conditions and functional outcomes.
authors.affiliation: Department of Otolaryngology, Hospital Universitario del Henares, Avda Marie Curie s/n, 28822, Coslada, Madrid, Spain. mmarcos.fernandezf@salud.madrid.org.|Otolaryngology Head & Neck Surgery Department, MD Anderson International, c/Arturo Soria 270, 28033, Madrid, Spain. mmarcos.fernandezf@salud.madrid.org.
authors.forename: Mario M
authors.initials: MM
authors.lastname: Fernández-Fernández
authors.affiliation: Otolaryngology Head & Neck Surgery Department, MD Anderson International, c/Arturo Soria 270, 28033, Madrid, Spain.
authors.forename: Lourdes
authors.initials: L
authors.lastname: Montes-Jovellar
authors.affiliation: Department of Otolaryngology, Hospital Universitario de A Coruña, As Xubias s/n, 15006, A Coruña, Spain.
authors.forename: Pablo Luis
authors.initials: PL
authors.lastname: Parente Arias
authors.affiliation: Department of Otolaryngology, Hospital Universitario de Móstoles, c/Río Júcar s/n, 28935, Mostoles, Madrid, Spain.
authors.forename: Primitivo
authors.initials: P
authors.lastname: Ortega Del Alamo
mesh_terms: D000368:Aged; D002277:Carcinoma / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000601:surgery*; D007441:Intubation, Gastrointestinal / Q000706:statistics & numerical data; D007822:Laryngeal Neoplasms / Q000601:surgery*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery; D009959:Oropharyngeal Neoplasms / Q000601:surgery*; D011446:Prospective Studies; D059708:Ultrasonic Surgical Procedures
keywords: Hypopharyngeal carcinoma; Oropharyngeal carcinoma; Robotic surgery; Supraglottic carcinoma; Thunderbeat; Transoral surgery