Transoral robotic surgery: Role in the management of upper aerodigestive tract tumors

Abstract

The toxicity associated with concomitant chemoradiation for the management of laryngeal and pharyngeal carcinoma has been well documented. Minimally invasive surgical techniques offer the potential to extirpate the malignancy as a single-modality therapy and provide essential information that may direct subsequent treatment. In selected patients, radiation doses may be reduced and systemic chemotherapy may be withheld after tumor extirpation. Transoral laser microsurgery has proven effective, although inability to manipulate and suture tissue by this modality limits ablation and reconstruction of extensive defects. Transoral robotic surgery is a relatively new technique that provides several unique advantages, which include a 3-dimensional magnified view, ability to see and work around curves or angles, and the availability of 2 or 3 robotic arms that can be used to reconstruct extensive defects using either local, regional, or free flaps. Preliminary data suggest that transoral robotic surgery may provide a technique for ablation and reconstruction of pharyngeal defects that may be superior to other transoral techniques. It may also provide a means for personalizing therapy for oropharyngeal and supraglottic carcinoma.

Transoral Robotic Surgery for Atypical Carcinoid Tumor of the Larynx

“…9 The robot provides three-dimensional images through a dualendoscope mechanism, robotic instrumentation provides a wide range of motions unavailable with traditional endoscopic instruments, scaling of movement allows large movements of the hands to produce only small movements in the robotic instruments, and the robot dampens hand tremors. 10 The initial oncologic and functional outcomes after TORS supraglottic laryngectomy are very encouraging. Transoral robotic surgery provides a safe, effective, and minimally invasive approach for the larynx without a necessity for tracheotomy.…”

Minimally invasive techniques for head and neck malignancies: current indications, outcomes and future directions

“…A recent review by Genden et al [42] concluded that TORS has proven to be a safe and feasible treatment for tumors of the upper aerodigestive tract and that initial studies have shown low morbidity associated with a TORS surgical approach. Ongoing prospective studies are poised to demonstrate that oncologic outcomes using TORS are equivalent or possibly superior to combined chemoradiation therapy and that while most surgical defects can be allowed to heal by secondary intention, transoral robotic reconstruction is feasible, safe and eVective for larger tumors that require Xap reconstruction after excision.…”

Transoral endoscopic head and neck surgery (eHNS) for minor salivary gland tumors of the oropharynx

“…Transoral laser microsurgery (TLM) is an invaluable component in the management of upper airway malignancies, and the clinical utility of transoral robotic surgery (TORS) is becoming increasingly well-established [1][2][3][4][5][6][7].…”