Transoral Excision of a Retropharyngeal Lymph Node under Rigid Endoscopic Control

Abstract

Different traditional surgical approaches, such as transcervical, transparotid, and mandible-splitting procedures, have been described to expose the retropharyngeal space. The introduction of the transoral approach, in selected patients, provided a direct and adequate access to the retropharyngeal space, permitting a feasible and minimally invasive procedure to remove retropharyngeal lymph nodes. We report a case of a transoral video-assisted approach for the excision of a retropharyngeal lymph node in a young man who had previously been treated at another institution by surgery and radiotherapy for oral tongue cancer. The endoscopic magnification allowed us to perform a meticulous and relatively bloodless dissection of the lesion from the surrounding tissues with a clear identification of the anatomic structures, and therefore may represent a valid alternative to the use of a microscope or loupes to enhance vision. A clear understanding of the anatomy of the retropharyngeal space and a high degree of surgical expertise are required to perform a safe dissection of the lesion.

Transoral robotic retropharyngeal node dissection

“…Direct transoral and TORS approaches have been described for resection of RPLN metastases from PTC . More recently, transoral and TORS approaches have been published for resection of RPLN metastases from oropharyngeal SCC . Our study is the second largest series to date using TORS for RPLN dissection.…”

Transoral Robotic Retropharyngeal Lymph Node Dissection With or Without Lateral Oropharyngectomy

“…If a navigation system could be applied to the robotic system in the future, it would greatly facilitate transoral robotic RPLN dissection without lateral oropharyngectomy. 20 This study, however, has limitations because of the fact that this was a small population study. However, this is the first to report the feasibility of transoral robotic RPLN dissection with or without lateral oropharyngectomy for head and neck squamous cell carcinomas with RPLN metastasis.…”

“…However, as has been previously described by others, although this approach can directly access the retropharyngeal space with technical ease, there is still a certain degree of limited surgical access where application of this technique to cases with macroscopic ECS or invasion of surrounding structures is troublesome. 20,22 On the basis of the previous reports made by others on the technical feasibility of transoral retropharyngotomy to remove the RPLNs, the authors have applied the robotic surgical system to complement its shortcomings. To our knowledge, this robotic surgical technique of transoral RPLN dissection has never been reported in the literature before.…”

Trans-oral robotic surgery and surgeon-performed trans-oral ultrasound for intraoperative location and excision of an isolated retropharyngeal lymph node metastasis of papillary thyroid carcinoma

“…The ease of use of the articulating robot instrument arms coupled with the 3-dimensional optics of the camera gives the surgical robot advantages over the use of an endoscope (that has a 2 dimensional view) and long transoral non-articulating instruments. This use of a rigid endoscope has been reported as being effective for transoral retropharyngeal excision [11]. We think that the 3-D view and articulating arms of the robot likely bring superior visualization and maneuvering ability possibly making the operation safer, more efficient, and more effective in clearing all disease.…”

“…Surgical excision of isolated retropharyngeal lymph node metastases from WDTC has been well described via trans-cervical, trans-mandibular, and trans-oral approaches, including endoscopic-assisted trans-oral resection [5][6][7][8][9][10][11]. Trans-oral robotic surgery (TORS) has been described for excision of metastatic retropharyngeal lymph nodes of oropharyngeal carcinoma and of parapharyngeal space tumors, but never for an isolated retropharyngeal metastasis from WDTC [12][13][14][15][16].…”