Transoral Robotic Retropharyngeal Lymph Node Dissection With or Without Lateral Oropharyngectomy

Abstract

Retropharyngeal lymph node (RPLN) metastases can occur from advanced head and neck malignancies. Surgical access to RPLNs can be challenging. Considering the more aggressive conventional approach methods, there is an increasing need for minimally invasive techniques. Applying transoral robotic surgery (TORS) to access the RPLN has never been reported in the literature. The purpose of this study was to describe our experience with transoral robotic RPLN dissection for oropharyngeal and hypopharyngeal squamous cell carcinomas. We conducted a retrospective review of TORS cases performed at Severance Hospital, a tertiary care medical center from December 2011 to July 2012. Demographic, clinicopathologic, and treatment characteristics were abstracted from the medical record as well as complications and were analyzed descriptively. A total of 5 TORS procedures with transoral robotic RPLN dissection have been performed at Severance Hospital. Of these, 4 patients were treated for oropharyngeal squamous cell carcinoma and 1 for hypopharyngeal squamous cell carcinoma. The mean operation time for TORS including the robotic RPLN dissection was 84 ± 18.5 minutes. The operation time included time for docking of the robotic arms (4.8 ± 1.3 minutes), console working time for primary tumor removal (50 ± 8.9 minutes), and console working time for RPLN dissection (29.2 ± 9.4 minutes). No patients experienced complications related to the transoral robotic RPLN dissection. Transoral robotic RPLN dissection is a feasible approach for accessing retropharyngeal lymph nodes. This particular operative technique can serve as a minimal invasive surgery in removing pathologic RPLNs.

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

“…If desired, an angled view can also be obtained through a beveled endoscopic camera. These all can be very helpful in identifying and preserving adjacent neurovascular structures of the retropharyngeal and parapharyngeal spaces while maximizing and the adequacy of resection [12,13,20,21]. 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.…”

“…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].…”

Transoral Videolaryngoscopic Surgery with a Navigation System for Excision of a Metastatic Retropharyngeal Lymph Node

“…Shellenberger et al [10] reported 3 cases of differentiated thyroid carcinoma safely removed by a transoral approach guided by preoperative ultrasonography. Byeon et al [11] also reported the removal of parapharyngeal tumors by transoral robotic surgery. Liu et al [13] noted the usability of intraoperative cone beam CT guidance with transoral robotic surgery in the oropharyngeal region of porcine and cadaveric models.…”

“…The key to successfully operate RPS lesions is to ensure an adequate surgical field as well as an adequate view enabling the identification of surrounding vital nerves and vessels. Surgical approaches to the RPS are classified as transcervical [5] or transoral [9,10,11]. A transcervical approach is conventionally chosen as an extension of neck dissection.…”

The Role of Transoral Robotic Surgery in the Management of Oropharyngeal Squamous Cell Carcinoma: a Current Review

“…Radiographic involvement of the RPLN occurs in approximately 10-16 % of OPSCC patients, is associated with more advanced disease, and confers a worse prognosis [22,23]. More recently, Byeon et al [24] reported on the feasibility of TORS RPLN dissection with or without lateral oropharyngectomy, a technique that has also been applied to the resection of RPLN metastases from papillary thyroid cancer [25]. The authors commented that TORS along with a detailed knowledge of the anatomy offers a minimally invasive technique for removing pathologic nodes while preserving the surrounding neurovascular structures.…”