title: Transoral videolaryngoscopic surgery with a navigation system for excision of a metastatic retropharyngeal lymph node.
abstract: OBJECTIVE
  To report the utilization of a new transoral surgery system, i.e. transoral videolaryngoscopic surgery (TOVS) with a navigation system, for the removal of a metastatic retropharyngeal lymph node (RPLN).
  
  
  METHODS
  An 86-year-old woman with tongue cancer (cT2N0M0) underwent partial glossectomy and left selective neck dissection. Three months postoperatively, a left metastatic RPLN was identified on follow-up magnetic resonance imaging. The metastatic RPLN was successfully excised by TOVS with a navigation system. After postoperative irradiation, she had no recurrence more than 1 year after the surgery.
  
  
  CONCLUSIONS
  The retropharyngeal space (RPS) is a difficult area to access surgically. A transcervical approach is conventionally used to access the RPS; however, in the present case, scar tissue after neck dissection may have been problematic. Visualization of the RPS by high-definition endoscopy and a navigation system were effective in facilitating the safe performance of the surgery.
  
  
  CONCLUSIONS
  A transoral approach may be a viable choice for surgery of a metastatic RPLN. Surgical indications for a transoral approach to the RPS include that (1) the location of the RPLN is below the level of the hard palate and the pterygoid hamulus and (2) there is only a single lesion, without adhesion to the surrounding tissue.
authors: Department of Otolaryngology - Head and Neck Surgery, National Defense Medical College, Tokorozawa, Japan.
authors: Yuya
authors: Y
authors: Tanaka
authors: Masayuki
authors: M
authors: Tomifuji
authors: Hiroshi
authors: H
authors: Suzuki
authors: Taku
authors: T
authors: Yamashita
authors: Koji
authors: K
authors: Araki
authors: Akihiro
authors: A
authors: Shiotani
mesh_terms: D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007828:Laryngoscopy / Q000379:methods*; D008197:Lymph Node Excision / Q000295:instrumentation*; D008207:Lymphatic Metastasis; D009333:Neck / Q000473:pathology*; D014062:Tongue Neoplasms / Q000473:pathology*; D020535:Video-Assisted Surgery