The Emergence of Endoscopic Head and Neck Surgery

Abstract

Endoscopic and minimally invasive techniques represent a natural evolution for the discipline of head and neck surgery. Endoscopic head and neck surgery (eHNS) encompasses transoral laser microsurgery, transoral robotic surgery, as well as video-assisted and robotic surgery of the neck and thyroid. In the next 5 years, with robotic surgery and laser technology as a common platform, we foresee the development and widespread use of eHNS procedures, via transoral and transaxillary approaches.

Prospects of Robotic Thyroidectomy Using a Gasless, Transaxillary Approach for the Management of Thyroid Carcinoma

“…[6][7][8][9][10][11] Subsequently, many thyroid surgeons have adopted robotic thyroidectomy, and several teams have reported their successful experiences of this new approach. [18][19][20][21][22][23][24] Before the first application of robotics to thyroid surgery in 2007, the authors had performed more than 650 endoscopic thyroidectomies using gasless TAA from 2001. We started robotic thyroid surgery based on the feasibility and the safety of endoscopic thyroidectomy in papillary thyroid microcarcinoma, 5,16 but we limited initial cases to well-differentiated thyroid carcinoma with a tumor size of r2 cm without definite extrathyroidal tumor invasion (T1 lesions) or to follicular neoplasms with a tumor size of r5 cm.…”

“…Several surgeons have described their initial experiences of robotic thyroidectomy using TAA, and all have emphasized the importance of adequate training and patient selection before starting robotic thyroid surgery. [18][19][20][21][22][23][24] Robotic thyroidectomy is an exciting new technology, but the procedure is complex and the operative field and robotic facilities are unfamiliar, even to surgeons experienced at open thyroidectomy. The procedure requires a complete understanding of approaching routes, anatomy, and robotic instruments, and thus, sufficient training is absolutely necessary and requires careful observation of an expert's technique and animal or cadaveric studies.…”

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

“…Paradigms for treating oropharyngeal cancer have generally favoured chemo-radiotherapy over surgery, due to acceptable locoregional control from chemoradiotherapy and operative morbidity [9,10]. However the ability to surgically instrument the oropharynx and safely provide tumour clearance without facing the complications from chemo-radiotherapy remains attractive and therefore these techniques warrant further research.…”

Transoral Robotic Surgery with Laser for Head and Neck Cancers: A Feasibility Study

“…The binomial treatment decision making of T1-T2 malignancies involving the oropharyngeal and laryngeal area states the equivalent curative effectiveness of surgical and nonsurgical therapies [1,2,3]. Microscopic laser surgery and more recently transoral robotic surgery (TORS) introduced surgeons to a new fascinating surgical era, reducing the notorious consequences of open access approaches [4]. …”