Determination of biometric measures to evaluate patient suitability for transoral robotic surgery

Arora, Asit; Kotecha, Jalpa; Acharya, Amish; Garas, George; Darzi, Ara; Davies, D. A. L.; Tolley, Neil

doi:10.1002/hed.23739

Cited by 36 publications

(43 citation statements)

References 43 publications

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“…Lim et al 70 evaluated the anatomy of the oropharynx and identified the key landmarks, including the glossopharyngeal nerve, styloglossus muscle, and external carotid artery, and explained that highlighting these key anatomic landmarks during training may help to shorten the learning curve of the TORS procedure. Arora et al 71 evaluated patient selection for the procedure, which is currently qualitatively assessed by exam under anesthesia. However, a number of quantitative biometrics are already being used to predict the difficulty of intubation, and similar objective measurements exist in which to better guide the surgical approach.…”

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confidence: 99%

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Transoral Robotic Surgery in Oropharyngeal Carcinoma

Helman¹,

Schwedhelm²,

Kadakia³

et al. 2015

Archives of Pathology &Amp; Laboratory Medicine

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Context The incidence of oropharyngeal squamous cell carcinoma has increased during the past decade and is related primarily to the human papillomavirus. This change in etiology, from tobacco and alcohol to human papillomavirus, has resulted in improved survival for the disease. In the United States, open resection had largely been replaced by concurrent chemotherapy and/or radiotherapy by the early 2000s. The advent of transoral surgery has led to an increase in surgery as the primary treatment for both early- and advanced-stage oropharyngeal squamous cell carcinoma because it has potential advantages over open surgery and nonsurgical modalities. Objective To provide an overview of transoral robotic surgery for oropharyngeal squamous cell carcinoma and contrast it with other surgical and nonsurgical modalities. Data Sources Articles from 2000 to 2014 were accessioned on PubMed and reviewed for utility by the primary authors. Conclusions Transoral surgery has become more commonly used as a minimally invasive approach to treat oropharyngeal tumors. Other strategies, including radiation, chemotherapy with radiation, and open surgery, are still important treatment approaches. The treatment options for an individual patient rely on multiple factors, including the tumor location and size, features of the tumor, and patient comorbidities. The continued study of these techniques is important to match the patient with the most appropriate treatment.

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confidence: 99%

“…The incorporation of this practice may decrease surgical morbidity through better selection of TORS candidate patients by removing qualitative predictions and variability between surgeons. 71 …”

mentioning

confidence: 99%

Transoral Robotic Surgery in Oropharyngeal Carcinoma

Helman¹,

Schwedhelm²,

Kadakia³

et al. 2015

Archives of Pathology &Amp; Laboratory Medicine

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“…We only used the FKWO retractor for hypopharyngeal exposure; no other gags such as Davis gag was used. However, visualization of the epiglottis was significantly better using the FK retractor compared to the Davis gag [18]. Thus, evaluation with the FKWO retractor in this study was appropriate.…”

Section: Discussionmentioning

confidence: 88%

“…Inadequate target exposure that could not permit TORS was reported to occur in 7-26% of cases [2,17]. Identifying patients who are unsuitable is crucial to preventing unnecessary general anesthesia and minimizing the time and financial costs of abandoned TORS and conversion to open surgery [18].…”

Section: Discussionmentioning

confidence: 99%

Preoperative predictors of difficult hypopharyngeal exposure by retractor for transoral robotic surgery

et al. 2018

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Introduction Transoral endoscopic surgeries provide excellent oncologic outcomes while preserving speech and swallowing ability. However, feasibility has been a major concern about transoral surgery. Therefore, ensuring visualization of the surgical field and sufficient working space is required. The aim of this study was to evaluate the parameters in the preoperative assessment that affect hypopharyngeal exposure. Methods Before transoral surgery, parameters regarding the patient's neck and face such as modified Mallampati index, thyroid-mental distance (TMD), and ability to fully open the mouth were evaluated. Cephalometry and cervical spine radiography were performed preoperatively to evaluate the size of the mandible bone, mouth opening, and cervical spine extension. Mandibular bone parameters such as intergonion distance, mental-gonion distance, articulare-gonion distance, and aperture angle were measured. According to hypopharyngeal exposure using FKWO retractor, patients were divided into difficult hypopharyngeal exposure group (DHE) and non-difficult hypopharyngeal exposure group (non-DHE). Parameters were enrolled to evaluate the relationship between these parameters and DHE status. Results This study included 51 patients, 37 in the non-DHE group and 14 in the DHE group. On radiographic evaluation, there was a significant difference in the degree of cervical lordosis between non-DHE and DHE patients. A significantly higher proportion of DHE patients had a history of radiotherapy compared with non-DHE patients. Conclusion Patients with limited cervical extension and a history of previous radiotherapy might have difficult hypopharyngeal exposure during transoral surgery. This is the first report to suggest a classification system for hypopharyngeal exposure during transoral surgery.

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“…Initial indications for TORS involved base of tongue neoplasms, but, with increasing experience combined with preclinical studies on animals and cadavers, these rapidly expanded [17]. Currently, TORS constitutes a valuable treatment modality for tumours of the oropharynx (including advanced oropharyngeal carcinoma) [18], hypopharynx [19], parapharyngeal space [20], and supraglottic larynx [21].…”

Section: Transoral Robotic Surgerymentioning

confidence: 99%

Robotic Head and Neck Surgery: History, Technical Evolution and the Future

Garas

Arora

2018

ORL

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The first application of robotic technology in surgery was described in 1985 when a robot was used to define the trajectory for a stereotactic brain biopsy. Following its successful application in a variety of surgical operations, the da Vinci® robot, the most widely used surgical robot at present, made its clinical debut in otorhinolaryngology and head and neck surgery in 2005 when the first transoral robotic surgery (TORS) resections of base of tongue neoplasms were reported. Subsequently, the indications for TORS rapidly expanded, and they now include tumours of the oropharynx, hypopharynx, parapharyngeal space, and supraglottic larynx, as well as obstructive sleep apnoea (OSA). The da Vinci® robot has also been successfully used for scarless-in-the-neck thyroidectomy and parathyroidectomy. At present, the main barrier to the wider uptake of robotic surgery is the prohibitive cost of the da Vinci® robotic system. Several novel, flexible surgical robots are currently being developed that are likely to not only enhance patient safety and expand current indications but also drive down costs, thus making this innovation more widely available. Future directions relate to overlay technology through augmented reality/AR that allows real-time image-guidance, miniaturisation (nanorobots), and the development of autonomous robots.

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Determination of biometric measures to evaluate patient suitability for transoral robotic surgery

Abstract: Mandibular body height, hyoid-mental length, and neck circumference in conjunction with the degree of mouth opening may determine patient suitability for TORS. Clinical evaluation is essential to validate their collective usefulness.

Cited by 36 publications

References 43 publications

Transoral Robotic Surgery in Oropharyngeal Carcinoma

Transoral Robotic Surgery in Oropharyngeal Carcinoma

Preoperative predictors of difficult hypopharyngeal exposure by retractor for transoral robotic surgery

Robotic Head and Neck Surgery: History, Technical Evolution and the Future

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