Transoral Robotic Surgery Using the Thulium:YAG Laser&lt;subtitle&gt;A Prospective Study&lt;/subtitle&gt;

Abel, Kathryn M. Van; Moore, Eric J.; Carlson, Matthew L.; Davidson, Jennifer; García, Joaquín J.; Olsen, Steven M.; Olsen, Kerry D.

doi:10.1001/archoto.2011.1199

Cited by 33 publications

(29 citation statements)

References 20 publications

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“…Rates of perioperative feeding tube placement varied widely by disease stage and institutional practices (3% to 100%), and the average duration of perioperative nasogastric tubes was 2 to 13 days. 11,13,17,18 Excluding prophylactic placement, 15 18% to 39% of patients required gastrostomy placement, typically during adjuvant therapy. A single study of radical tonsillectomy reported the placement of gastrostomy tubes intraoperatively in all patients.…”

Section: Resultsmentioning

confidence: 99%

“…Excluding studies that restricted inclusion to early stage disease and those that routinely prophylactically placed PEG tubes, 18% to 39% required PEG tubes in TORS series 11–13,16,18–19 compared with 29% to 60% of patients in definitive IMRT series 6,20–25 (Figure 2). …”

Section: Resultsmentioning

confidence: 99%

“…13 In contrast, only 51% of patients began oral intake on POD #1 after TORS when data were reported for patients of all T-stages (T1–T4). 11 Among series including all T-stages, 69%–73% began oral intake by discharge, 18,26 83% by week 2, 25 and 89% by week 4. 11 …”

Section: Resultsmentioning

confidence: 99%

“…10,17, 26 Finally, the incidence of postoperative pneumonia was reported in 3 studies and ranged from 0% to 7%. 14,15,18 …”

Section: Resultsmentioning

confidence: 99%

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Functional outcomes after TORS for oropharyngeal cancer: a systematic review

Hutcheson

Holsinger

Kupferman

et al. 2014

Eur Arch Otorhinolaryngol

198

191

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OBJECTIVE Summarize functional outcomes after transoral robotic surgery (TORS) ± adjuvant therapy for oropharyngeal cancer (OPC). STUDY DESIGN A systematic review was conducted. The MEDLINE database was searched (MeSH terms: transoral robotic surgery, pharyngeal neoplasms, oropharyngeal neoplasms). METHODS Peer-reviewed human subject papers published through December, 2013 were included. Exclusion criteria were: 1) case report design (n<10), 2) review article, or 3) technical, animal or cadaver studies. Functional outcomes extracted included feeding tube dependence, swallow examination findings, speech ratings, velopharyngeal insufficiency, pneumonia, and oral intake measures. RESULTS Twelve papers comprising 441 patients with OPC treated with TORS ± adjuvant therapy were included. Feeding tube rates were the most commonly reported functional outcome. Excluding prophylactic placement, 18% to 39% of patients required gastrostomy placement, typically during adjuvant therapy. Chronic gastrostomy dependence ranged from 0% to 7% (mean follow-up: 11–26 months), regardless of disease stage. Composite MD Anderson Dysphagia Inventory (MDADI) scores ranged from 65.2 to 78 (89 patients, 3 series, mean follow-up: 12–13 months). Videofluoroscopic swallowing studies were not systematically reported. Incidence of postoperative pneumonia was 0% to 7%. Predictors of swallowing function included baseline function, T-stage, N-stage, tongue base primary tumors, and adjuvant chemoradiation. Rates of transient hypernasality were 4% to 9%. A single study suggested dose-dependent effects of adjuvant therapy (none, radiation alone, chemoradiation) on diet scores at 6- and 12-months. CONCLUSIONS Crude endpoints of functional recovery after TORS ± adjuvant therapy suggest promising swallowing outcomes, depending on the functional measure reported.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…10,17, 26 Finally, the incidence of postoperative pneumonia was reported in 3 studies and ranged from 0% to 7%. 14,15,18 …”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Functional outcomes after TORS for oropharyngeal cancer: a systematic review

Hutcheson

Holsinger

Kupferman

et al. 2014

Eur Arch Otorhinolaryngol

198

191

View full text Add to dashboard Cite

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“…The surgeon is provided with an endoscopically derived three-dimensional visual display that is colocated with control handles that direct movements of the robot's instruments inside the patient's body. Standard surgical instruments, including tissue forceps, a spatulated electrocautery device, or carbon dioxide 20 and thulium laser, 21 are then used to perform an en bloc resection of the oropharyngeal tumor. A bedside assistant provides countertraction and suction while caring for the patient throughout the procedure (Fig 3).…”

Section: Torsmentioning

confidence: 99%

Transoral Endoscopic Head and Neck Surgery and Its Role Within the Multidisciplinary Treatment Paradigm of Oropharynx Cancer: Robotics, Lasers, and Clinical Trials

Holsinger

Ferris

2015

JCO

142

144

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Transoral endoscopic head and neck surgery is a new approach for the treatment of oropharyngeal tumors. Using either a robotic system and/or laser, surgeons gain access through the mouth via minimally invasive technique and thus have improved visualization of the tumors of the oropharynx, without disfiguring incisions. This transoral route of access minimizes long-term speech and swallowing dysfunction. Surgeons view this approach as a considerable technologic advance, analogous to the evolution in radiation therapy from conventional two- and three-dimensional conformal techniques to intensity-modulated techniques. Although the use of radiation with or without chemotherapy to treat oropharyngeal cancer (OPC) is supported by evidence from prospective clinical trials, there are no prospective data supporting the use of this new surgical approach for OPC. Here, we review the fundamentals of transoral endoscopic head and neck surgery, with robotics and laser technology, and discuss ongoing clinical trials for patients with OPC.

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