Abstract
The article reviews the use of robotic technology for head and neck tumours. The authors discuss the development of transoral robotic surgery (TORS), the current status of the technology, and the set-up in the operating room. The article provides a review of the literature, highlighting the applications, advantages, functional outcomes, and disadvantages of TORS for each anatomic subsite (oropharynx, hypopharynx, larynx, parapharyngeal space, and skull base). New challenges related to reconstruction are also presented. Overall early functional and oncologic outcome data are promising; further long-term prospective trials are still needed to confirm the oncological safety of TORS.
Highlights
Transoral robotic surgery (TORS) was first introduced in [4] by Weinstein et al with a case report of a supraglottic laryngectomy in a canine model and by MacLeod and Melder [5], who reported the excision of a vallecular cyst in a human patient with a setup time of 75 min and a surgical time of 30 min
All the patients underwent TORS radical tonsillectomy for invasive squamous cell carcinoma (SCC) of the tonsillar region, staged neck dissection, and adjuvant therapy
Cohen et al reported the outcome profile of oropharyngeal SCC treated with TORS comparing two different groups of patients: HPV-positive and negative
Summary
Robotic-assisted surgery has its roots in 1972, when the National Aeronautics and Space Administration began to investigate a method to provide surgical care to orbiting astronauts through telepresence surgery [1]. Transoral robotic surgery (TORS) was first introduced in [4] by Weinstein et al with a case report of a supraglottic laryngectomy in a canine model and by MacLeod and Melder [5], who reported the excision of a vallecular cyst in a human patient with a setup time of 75 min and a surgical time of 30 min. Since these early reports, the development of TORS has been steadily progressing and many other studies on TORS in animal cadavers, human subjects, and various head and neck cancer sites have been published. Because of the possibility of obtaining superior visualisation and complete resection of tumours with wide margins, TORS seems to represent an alternative to open or endoscopic/microscopic approaches in oral and pharyngolaryngeal oncology— with 5-mm instruments—that allows improved vision, greater ease of use, and a shorter operating time [10]
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