Robotic Surgery and Transoral Laser Surgery in Head and Neck

61 Robotic Surgery and Transoral Laser Surgery in Head and Neck


61.1 Robotic Surgery in Head and Neck


• History


figure Da Vinci Robot


figure 1st ever robotic operation was a heart bypass in Leipzig, Germany, in 1998


figure 1st transoral resection by Weinstein/O’Malley at University of Pennsylvania, USA, 2004


• Indications


figure Oropharyngeal, laryngeal, hypopharyngeal malignancy


figure Parapharyngeal tumours


figure Thyroid and parathyroid surgery


figure (Initial cadaveric studies show tongue base hypertrophy contributing to obstructive apnea may be an application for the robot)


• Advantages


figure Increased visualization and precision through limited access


figure Transoral approach


figure Reduced surgical time


figure Shorter hospital stay


figure Avoidance/dose reduction in chemo/RT


• Disadvantages


figure Expense


figure Learning curve for surgeons and theatre staff


figure Limited software to run the robot


figure No tactile feedback


• Setup


figure Surgeon’s console (in room with patient)


figure Instrument cart with robot with 4 interactive robotic arms adjacent to patient


figure 3 arms are holders for instruments such as scalpel, scissor, and cautery


figure 1 arm is a camera (0° or 30°) with 2 lenses affording stereoscopic vision


figure Surgeon looks via the wired vision cart at a high-definition 3D image on the console while using 2 foot- and 2 hand-controlled pedals that move the arms


figure Movements by the surgeon are converted into microscopic movements by the robot’s computer system


figure The range of movement is 540° of rotation


figure Computerized motion scaling eliminates tremors and fatigue


figure Process relies on human operator for all input


figure Future developments include remote operating, i.e., the patient and robot are in a different place to the surgeon; role in metastatic SCC in the neck; and development of haptic feedback systems


61.2 Transoral Laser Surgery in Head and Neck


• History


figure 1985 Steiner, Ambrosch: University of Göttingen, Germany


figure See Table 61.1


• Advantages


figure Less local recurrence


figure Less salvage laryngectomy


figure Organ sparing


figure Morbidity/complication rate lower


• Disadvantages


figure Laser injury


figure Learning curve


• European Laryngological Society classification of endoscopic resection (Fig. 61.1)


figure Type I—subepithelial cordectomy


– Resection VF epithelium passing through the superficial layer of lamina propria


figure Type II—subligamental cordectomy


– Resection of epithelium, Reinke space, and the vocal ligament


figure Type III—transmuscular cordectomy


– Resection of the VF down through vocalis muscle


figure Type IV—total cordectomy


– Resection of the cord that extends from the vocal process to the anterior commisure ± internal perichondrium of the thyroid ala


figure Type V—Extended cordectomy


– Va: + contralateral vocal fold and anterior commissure


– Vb: + arytenoids


– Vc: + subglottis


– Vd: + ventricle and false cords



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Jul 4, 2016 | Posted by in OTOLARYNGOLOGY | Comments Off on Robotic Surgery and Transoral Laser Surgery in Head and Neck

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