Abstract

Transoral videolaryngoscopic surgery (TOVS) for laryngopharyngeal cancer developed by Shiotani et al., uses the laparoscopic surgical system and distending laryngoscope. This method enables precise procedures and en bloc resection under a good view with videoendoscope in the structurally complex laryngopharynx. The major indications are Tis-2, and selected T3 lesions of hypopharyngeal, oropharyngeal, and supraglottic laryngeal cancer. TOVS is also considered for resectable rT1 and rT2 radiation failure cases and selected T3–4 advanced cases following neoadjuvant chemotherapy. Patients with resectable lymph node metastases are treated by neck dissection. Major contraindications are cricoarytenoid joint fixation, circumferential invasion of more than half, bilateral arytenoid invasion, and invasion to the thyroid cartilage, cricoid cartilage, hyoid bone, deep pharyngeal constrictor muscle. Oncological outcomes are good in long-term survival and larynx preservation rates with sparing radiation in half of the patients. However, advanced T stage and N3 cases showed a worse prognosis. Regarding functional outcome, swallowing function can maintain in most patients. Postoperative voice impairment can occur after wound healing. TOVS has some advantages particularly for hypopharyngeal cancer, in maneuver with smaller diameter instruments and tactile sense, and in less invasiveness without a tracheostomy, compared to other transoral surgeries.

Highlights

  • Transoral videolaryngoscopic surgery (TOVS) for laryngopharyngeal cancer was developed by Shiotani and his colleagues in Japan since 2004 and the first report was published in 2010 [1–4]

  • TOVS has some advantages in maneuver and is less invasive compared to transoral laser microsurgery (TLM) and transoral robotic surgery (TORS), for hypopharyngeal cancer

  • TOVS is performed by two head and neck surgeons

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Summary

Introduction

Transoral videolaryngoscopic surgery (TOVS) for laryngopharyngeal cancer was developed by Shiotani and his colleagues in Japan since 2004 and the first report was published in 2010 [1–4]. This novel endoscopic transoral surgical system uses the laparoscopic surgical system and distending laryngoscope which enables en bloc resection under a good view with videoendoscope. Surgical instruments used in TOVS have been modified to some extent. Good long-term survival, larynx preservation, and functional outcomes were reported [5]. The tips and the pearls of TOVS including detail of the surgical procedures, managements, and outcomes are described

The feature of TOVS
Indications
Devices
Surgical procedures
Evaluation
Management of lymph node metastasis
Anatomical tips for TOVS in hypopharyngeal cancer
Perioperative management
Long-term management
Oncological management and additional treatments
Case2: 58 years-old male, hypopharyngeal cancer, rT2N0M0
10. Outcomes
10.3 Complications
11.1 Development of devices
11.2 Management of lymph node metastasis
12. Conclusions

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