Magnifying Endoscopy with Narrow Band Imaging to Determine the Extent of Resection in Transoral Robotic Surgery of Oropharyngeal Cancer

Abstract

Transoral robotic surgery (TORS) is a less invasive treatment that is becoming popular all over the world. One of the most important factors for achieving success in TORS is the ability to determine the extent of resection during the procedure as the extent of resection in the laryngopharynx not only affects oncological outcomes but also directly affects swallowing and voice functions. Magnifying endoscopy with narrow band imaging (ME-NBI) is an innovative optical technology that provides high-resolution images and is useful in detecting early superficial pharyngeal cancers, which are difficult to detect by standard endoscopy. A 55-year-old male with superficial oropharyngeal cancer has been successfully treated by combining MB-NBI with TORS and MB-NBI was useful in determining the extent of resection. ME-NBI with TORS will make it possible to achieve a higher ratio of minimally invasive treatment in pharyngeal cancer.

Is NBI-Guided Resection a Breakthrough for Achieving Adequate Resection Margins in Oral and Oropharyngeal Squamous Cell Carcinoma?

“…OPSCC has been addressed in 2 different case series. Patsias et al 36 showed that the use of high-resolution microendoscopy imaging during transoral robotic surgery (TORS) might provide real-time histological assessment of tumor margins, while Tateya et al 37 evaluated the feasibility and efficacy of NBI in determining the extent of OPSCC resection by TORS and found that it enabled an estimation of the horizontal extent of the superficial lesion and detection of surrounding superficial lesions normally not identified without NBI.…”

Endoskopische Frühdiagnostik von Karzinomen im oberen Aerodigestivtrakt

“…Ein weiterer möglicher Ansatz ist die Anwendung von Endoskopen mit bis zu 80facher Vergrößerungsmöglichkeit (‚magnification endoscopy') in Kombination mit NBI. Diese wurden beispielsweise für die Bestimmung der chirurgischen Absetzungsgrenzen bei der transoralen robotischen Chirurgie (TORS) angewendet [23].…”

Transoral robotic surgery advantages and disadvantages: a narrative review

“… Pharynx [23–30] : This category includes the publications for TORS in pharynx [23–25], nasopharynx (NP) [26] – located to the upper part of the pharynx –, parapharynx space tumours [27, 28] – located deep within the neck and it is a potential space lateral to the upper pharynx – and retropharynx [29, 30] – which is the posterior part of the pharynx – (see Table 2). Oropharynx [1, 31–52] : This category includes all the publications related to TORS, which refer to oropharyngeal carcinomas and tumours. The first subcategory includes publications which present the outcomes following TORS for oropharynx squamous cell carcinoma (OPSCC), such as swallowing, speech and quality of life (QOL) [40], the oncologic and functional outcomes [39, 52], postoperative bleeding with and without external carotid artery ligation [44].…”

“…Also, there are publications which compare the oncologic and functions between TORS and a treatment‐surgical approach [46], such as TORS versus definitive chemo‐radiotherapy (CRT) [41] and TORS versus traditional open surgical approaches [43]. The second subcategory includes publications which present a modified TORS approach, such as using magnifying endoscopy with narrow band imaging (ME‐NBI) with TORS in order to provide high‐resolution images and to detect early superficial pharyngeal cancers [34], or using a miniaturised high‐resolution fiberoptic microendoscope with TORS for providing real‐time histological assessment [36]. Also, another publication proposes a modified TORS approach in which transoral mandibular osteotomies are performed that can greatly improve exposure to oropharyngeal subsites and expand access to the larynx in selected patients [37].…”