Initial experience with image‐guided surgical navigation in transoral surgery

Muñoz

et al. 2021

Preprint

Introduction Surgery is the standard treatment for most tumors in the prestyloid parapharyngeal space (PPS) but it can be a challenging procedure because of the anatomical complexity of the area. Prestyloid surgery can be performed with various lateral approaches or with a medial approach using transoral robotic surgery (TORS) – either alone or in combination with a transcervical incision. Here we report our experience in the surgical management of prestyloid PPS tumors. Materials and Methods We have retrospectively compared results with lateral or medial approaches to surgical resection of prestyloid tumors. Between 2015 and 2020, 28 patients with prestyloid PPS tumors underwent surgery at our center: 14 with lateral approaches, including transcervical, transcervical-parotid, and transcervical-mandibular, 12 with TORS, and two with TORS plus a transcervical incision. Surgical time, post-surgical complications, length of hospital stay, need for feeding tube, and relapse-free survival in the two patient groups. Results Pleomorphic adenoma was the most frequent tumor and 60.7% of the tumors were benign. Tumor volume and maximum length were similar in patients undergoing surgery with a lateral approach and in those undergoing TORS. Intraoperative image guidance and ultrasound were used in 33% of TORS. TORS was associated with less surgical time, fewer complications, and shorter hospital stays. Survival rates were similar in the two groups. Conclusion The medial approach by TORS offers better surgical results in prestyloid tumors than the open lateral approach and can be refined by intraoperative guidance.

Section: Discussionmentioning

confidence: 99%

A Retrospective Analysis of Surgery in Prestyloid Parapharyngeal Tumors: Lateral Approaches vs Transoral Robotic Surgery

Muñoz

et al. 2021

Preprint

“…However, image‐guided surgery, though not yet in widespread use, is improving these conditions 20 and is a promising tool for reducing complications associated with TORS. 20 , 21 , 22 In our practice, we use ultrasound intraoperative guidance. It is based on echography guided by a Doppler 20 MHz probe with 1 cm of tissue penetration to identify the external branches of the facial and lingual arteries and the internal carotid artery.…”

Section: Discussionmentioning

confidence: 99%

A retrospective analysis of surgery in prestyloid parapharyngeal tumors: Lateral approaches vs transoral robotic surgery

Muñoz

Laryngoscope Investig Oto

et al. 2021

Objective: Surgery is the standard treatment for most tumors in the prestyloid parapharyngeal space (PPS) but it can be a challenging procedure because of the anatomical complexity of the area. Prestyloid surgery can be performed with various lateral approaches or with a medial approach using transoral robotic surgery (TORS)-either alone or in combination with a transcervical incision. We have retrospectively compared our center's results with lateral and medial approaches.Methods: Between 2015 and 2020, 28 patients with prestyloid PPS tumors underwent surgery at our center: 14 with lateral approaches, including transcervical, transcervical-parotid, and transcervical-mandibular, and 14 with medial approaches (12 with TORS and two with TORS plus a transcervical incision). We compared surgical time, postsurgical complications, length of hospital stay, need for feeding tube, and relapse-free survival in the two patient groups.Results: Pleomorphic adenoma was the most frequent tumor and 60.7% of the tumors were benign. Tumor volume and maximum length were similar in the two groups of patients. Intraoperative image guidance and ultrasound were used in 33% of TORS. TORS was associated with less surgical time, fewer complications, and shorter hospital stays. Recurrence rates were similar in the two groups. Conclusion:The medial approach by TORS offers superior results in prestyloid tumors than the open lateral approach and can be refined by intraoperative guidance.

“…However, image-guided surgery, though not yet in widespread use, is improving these conditions 20 and is a promising tool for reducing complications associated with TORS. [20][21][22] In our practice, we use two intraoperative assessment methods: an image-based navigational system and ultrasound guidance. Pre-surgical image-based navigational systems are known to be accurate, particularly in fixed bone frameworks.…”

Section: Discussionmentioning

confidence: 99%

A retrospective analysis of surgery in prestyloid parapharyngeal tumors: lateral approaches vs transoral robotic surgery

et al. 2020

Preprint

Objective Surgery is the standard treatment for most tumors in the prestyloid parapharyngeal space (PPS) but it can be a challenging procedure because of the anatomical complexity of the area. Prestyloid surgery can be performed with various lateral approaches or with a medial approach using transoral robotic surgery (TORS) -either alone or in combination with a transcervical incision. Here we report our experience in the surgical management of prestyloid PPS tumors. Design We have retrospectively compared results with lateral or medial approaches to surgical resection of prestyloid tumors. Participants Between 2015 and 2020, 28 patients with prestyloid PPS tumors underwent surgery at our center: 14 with lateral approaches, including transcervical, transcervical-parotid, and transcervical-mandibular, 12 with TORS, and two with TORS plus a transcervical incision. Main outcome measures Surgical time, post-surgical complications, length of hospital stay, need for feeding tube, and relapse-free survival in the two patient groups. Results Pleomorphic adenoma was the most frequent tumor and 60.7% of the tumors were benign. Tumor volume and maximum length were similar in patients undergoing surgery with a lateral approach and in those undergoing TORS. Intraoperative image guidance and ultrasound were used in 33% of TORS. TORS was associated with less surgical time, fewer complications, and shorter hospital stays. Survival rates were similar in the two groups. Conclusion The medial approach by TORS offers better surgical results in prestyloid tumors than the open lateral approach and can be refined by intraoperative guidance. Key points• Surgery of prestyloid tumors is challenging and requires meticulous planning based on tumor and patient characteristics. • Internal carotid artery position and parotid gland involvement are crucial points to consider in choosing a medial or lateral approach in prestyloid tumors. • Medial approaches to prestyloid tumor surgery are evolving along with technological evolution.• A medial approach with TORS achieves superior surgical results in prestyloid tumors than open lateral approaches. • TORS is feasible and safe for both benign and malignant prestyloid tumors in the hands of experienced surgical teams.