Robot-Assisted Reconstruction in Head and Neck Surgical Oncology: The Evolving Role of the Reconstructive Microsurgeon

Chalmers, Richard; Schlabe, Juergen; Yeung, Elizabeth; Kerawala, Cyrus; Cascarini, Luke; Paleri, Vinidh

doi:10.1159/000492787

Cited by 11 publications

(12 citation statements)

References 32 publications

(34 reference statements)

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“…Todavia, os autores constataram que os resultados dependem de alguns fatores, tais como a função de linha de base, o estágio T, e status do tratamento adjuvante. 34 Outro ponto importante sobre a TORS foi destacado por Chalmers et al 35 em seu estudo que discute o papel da reconstrução em defeitos pós-TORS, além do papel da reconstrução robótica na prática médica. Do mesmo modo, Li et al 36 analisaram a National Cancer Database, a base de dados de câncer dos Estados Unidos, para comparar os resultados em longo prazo de pacientes com carcinomas na orofaringe tratados com TORS, TLM e cirurgia não robótica.…”

Section: Resultsunclassified

Existe espaço para a microcirurgia na cirurgia robótica?

Silva

Busnello

Cesarino

et al. 2022

Rev Bras Ortop (Sao Paulo)

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ResumoA cirurgia robótica abriu uma nova era de procedimentos minimamente invasivos, por meio da sua precisão, da eliminação dos tremores, e dos maiores graus de liberdade e demais aspectos facilitadores. O campo da microcirurgia robótica apresentou grande crescimento nos últimos anos em especial, uma vez que a robótica oferece uma configuração potencialmente ideal para realização das manipulações delicadas exigidas na microcirurgia. Assim, conduzimos uma revisão sistemática com o objetivo de avaliar os benefícios da cirurgia robótica e sua contribuição para a microcirurgia, comparando-a com as demais técnicas cirúrgicas utilizadas em pacientes de todas as faixas etárias. Foram analisados 25 artigos encontrados nas bases de dados PubMed e Cochrane utilizando os descritores robotic surgery AND microsurgery com filtro para os últimos cinco anos, e estudos realizados em humanos e publicados em inglês ou português. Concluímos que existe grande espaço para a cirurgia robótica na microcirurgia, como em procedimentos primários de infertilidade masculina, microcirurgia neurológica, cirurgias oculares e otológicas, cirurgia transoral, hepatobiliar, microvascular, e cirurgia plástica e reconstrutiva.

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Section: Resultsunclassified

Existe espaço para a microcirurgia na cirurgia robótica?

Silva

Busnello

Cesarino

et al. 2022

Rev Bras Ortop (Sao Paulo)

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“…Gorphe [10 ▪▪ ] similarly used the robot for flap suturing in 36 of 50 (72%) patients within their series. Although application of the robotic system continues to expand, its efficacy compared to traditional techniques of flap inset and hand-sewn anastomoses will require large-scale, prospective studies for proper assessment [64].…”

Section: Recent Findingsmentioning

confidence: 99%

Oropharyngeal reconstruction after transoral robotic surgery

Silverman

Birkeland

Bewley

2022

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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Purpose of reviewTransoral robotic surgery (TORS) has experienced an evolution in recent years. This technique has proved to be a safe and effective method for extirpation of select oropharyngeal tumors. Advances in technology as well as improved surgeon experience allow for the resection of larger, more complex cancers. Although healing by secondary intention remains the current standard for limited oropharyngeal defects, larger resections demand reconstruction with vascularized tissue to minimize morbidity and optimize functional outcomes. The objective of this review is to evaluate recent literature regarding oropharyngeal reconstruction after TORS. Recent findingsA variety of reconstructive options to manage oropharyngeal defects exist. Several reconstructive algorithms have been suggested; however, careful consideration must be used to select the most ideal flap type. Locoregional flaps have shown excellent functional outcomes with limited morbidity. An increase in free flap reconstruction has been demonstrated, particularly among patients with larger TORS defects and following chemoradiation therapy. Despite limited data, robotic-assisted flap inset and microvascular anastomosis has recently shown promise. SummaryReconstruction and flap selection following TORS should be tailored to the patient and unique oropharyngeal defect. Functional outcomes are promising with low complication rates among these patients. Keywordsfree flap, locoregional flap, oropharyngeal reconstruction, transoral robotic surgery & ,5]. Importantly, TORS may obviate the need for open surgical approaches and adjuvant therapy, thereby reducing functional morbidity and toxicities [6,7 && ,8].Despite the advantages of robotic-assisted surgery, oropharyngeal resection with TORS may still result in sizeable defects which necessitate reconstruction. As indications for TORS expand to include larger and more complex resections, careful consideration is required to select the most appropriate

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“…If operating with a microscope that conveys high-definition video, one may consider use of the monitor to perform microsurgery in lieu of the eyepieces (Figure 4). Before the COVID-19 pandemic, transoral robotic surgery was gaining widespread use among head and neck oncologic and reconstructive surgeons, 30 with outcomes comparable to those of nonrobotic anastomoses with use of a standard operating microscope. 31 This would allow spatial segregation of the operating surgeon from the high-risk field.…”

Section: Innovations In Microsurgerymentioning

confidence: 99%

Microsurgery in the era of COVID-19

Payton

Wong

Lombana

et al. 2021

Baylor University Medical Center Proceedings

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The COVID-19 pandemic has presented new challenges to microsurgeons. The virus is highly transmissible, with increased risk during operations that involve the aerodigestive tract. It is important to be able to identify high-risk operations and scenarios to guide management decisions and selection of personal protective equipment. Preoperative testing is a key element in identifying high-risk scenarios, and preoperative testing protocols are essential to maintaining safety in the COVID-19 era. Because COVID-19 can be transmitted via the conjunctiva, adaptations to loupes and microscopes are necessary to safely perform microsurgery in high-risk scenarios. We outline a potential risk stratification algorithm, as well as precautions for each scenario. Potential areas for innovation are also discussed.

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Robot-Assisted Reconstruction in Head and Neck Surgical Oncology: The Evolving Role of the Reconstructive Microsurgeon

Cited by 11 publications

References 32 publications

Existe espaço para a microcirurgia na cirurgia robótica?

Existe espaço para a microcirurgia na cirurgia robótica?

Oropharyngeal reconstruction after transoral robotic surgery

Microsurgery in the era of COVID-19

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