Combined transoral robotic surgery and endoscopic endonasal approach for the resection of extensive malignancies of the skull base

Carrau, Ricardo L.; Prevedello, Daniel M.; Lara, Danielle de; Durmuş, Kasım; Özer, Enver

doi:10.1002/hed.23238

Cited by 81 publications

(57 citation statements)

References 45 publications

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“…Research to date on this subject is best summarized as involving (1) cadaveric modeling to assess the feasibility of these approaches to access the deep recesses of the midface and sub skull base [14]; (2) comprehensive meta-analysis and systematic review [15] and (3) clinical outcome studies [16].…”

Section: Discussionmentioning

confidence: 99%

Combined Transfacial and Endoscopic Approach to Resect a Posterior Pharyngeal wall Tumour in the Setting of Absolute Trismus

Hoffman¹,

Maher²,

Eisenberg³

2017

J Oncol Transl Res

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Section: Discussionmentioning

confidence: 99%

Combined Transfacial and Endoscopic Approach to Resect a Posterior Pharyngeal wall Tumour in the Setting of Absolute Trismus

Hoffman¹,

Maher²,

Eisenberg³

2017

J Oncol Transl Res

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“…Yin et al [33] first reported the clinical use of an endoscopic endonasal approach combined with a transoral robotic resection of a small recurrence at the superior aspect of the nasopharynx, Subsequently, a combined technique, using transoral robotic surgery and an endoscopic transpterygoid approach, to remove extensive malignant tumors of the posterior skull base, nasopharynx and ITF was developed and applied by Carrau et al [34] Avoidance of complications is one of the great surgical challenges.…”

Section: Discussionmentioning

confidence: 99%

Surgical Treatment of Nasopharyngeal Malignancies: Role of Endoscopic Endonasal Approaches

Kasemsiri

Prevedello

Otto

et al. 2014

J Nasopharyng Carcinoma

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Abstract:The development of endoscopic techniques has progressed onward with the recent enrichment of anatomical knowledge and experience, as well as the development of advanced technologies. Expansion of the clinical indications for endoscopic endonasal approaches has produced a paradigm shift in the surgical management of nasopharyngeal malignancies similar to that of other areas of the ventral skull base.Endoscopic endonasal nasopharyngectomy is a feasible minimal access technique indicated for the resection of select recurrent and radioresistant nasopharyngeal malignancies. It bestows the advantages of lack of external incisions or scars, decreased trauma to adjacent soft tissues and bone, reduced risk of neurological damage, and superior postoperative quality of life.A comprehensive review of the available literature shows that endoscopic surgery end-results are better than those yielded by re-irradiation or surgery via conventional open approaches. We acknowledge, however, that these results may be influenced by a bias in patient selection. Nonetheless, they suggest that, in properly selected cases, an endoscopic endonasal nasopharyngectomy affords low morbidity rates without compromising oncologic outcomes.Therefore, endoscopic endonasal approaches play a strong role in the treatment of nasopharyngeal malignancies.Nonetheless, one should be fully aware of the indications and limitations of using endoscopic endonasal approach to achieve optimal outcomes.

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“…5,11,41 In 2010, Yin Tsang et al published an original case report on the resection of a recurrent nasopharyngeal carcinoma using the combined endonasal and transoral approach. In their experience, the combined endonasal and transoral approach was required given the close proximity of the lesion to the skull base, necessitating the use of an endoscopic drill for bone resection, a surgical element that is still not feasible in standard TORS.…”

Section: Current Perspectives Of the Combined Eea And Tors Approachmentioning

confidence: 99%

“…Lastly, Carrau et al most recently presented their experience with the combined endonasal and transoral approach for the resection of various malignancies of the nasopharynx and skull base. 5 In their study, they demonstrated the feasibility of the combined approach through cadaveric and clinical study to complete nasopharyngectomies with lateral and inferior extensions to the middle skull base and costovertebral junction (CVJ), respectively. Additionally, they presented their clinical Fig.…”

Section: Current Perspectives Of the Combined Eea And Tors Approachmentioning

confidence: 99%

The combined endonasal and transoral approach for the management of skull base and nasopharyngeal pathology: a case series

Sreenath

Rawal

Zanation

2014

FOC

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The posterior skull base and the nasopharynx have historically represented technically difficult regions to approach surgically given their central anatomical locations. Through continued improvements in endoscopic instrumentation and technology, the expanded endonasal approach (EEA) has introduced a new array of surgical options in the management of pathology involving these anatomically complex areas. Similarly, the transoral robotic surgical (TORS) approach was introduced as a minimally invasive surgical option to approach tongue base, nasopharyngeal, parapharyngeal, and laryngeal lesions. Although both the EEA and the TORS approach have been extensively described as viable surgical options in managing nasopharyngeal and centrally located head and neck pathology, both endonasal and transoral techniques have inherent limitations. Given these limitations, several institutions have published feasibility studies with the combined EEA and TORS approaches for a variety of skull base and nasopharyngeal pathologies. In this article, the authors present their clinical experience with the combined endonasal and transoral approach through a case series presentation, and discuss advantages and limitations of this approach for surgical management of the middle and posterior skull base and nasopharynx. In addition, a presentation is included of a unique, simultaneous endonasal and transoral dissection of the nasopharynx through an innovative intraoperative setup.

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Combined transoral robotic surgery and endoscopic endonasal approach for the resection of extensive malignancies of the skull base

Abstract: TORS and EEA seem to be complementary techniques; thus, their combined use seems advantageous for selected advanced tumors in these complex areas.

Cited by 81 publications

References 45 publications

Combined Transfacial and Endoscopic Approach to Resect a Posterior Pharyngeal wall Tumour in the Setting of Absolute Trismus

Combined Transfacial and Endoscopic Approach to Resect a Posterior Pharyngeal wall Tumour in the Setting of Absolute Trismus

Surgical Treatment of Nasopharyngeal Malignancies: Role of Endoscopic Endonasal Approaches

The combined endonasal and transoral approach for the management of skull base and nasopharyngeal pathology: a case series

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