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Comparative analysis of resection tools suited for transoral robot-assisted surgery

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Abstract

Introduction of transoral robot-assisted surgery (TORS) has a strong potential to facilitate surgical therapy of head and neck squamous cell cancer (HNSCC) by decreasing the indication for an external surgical approach. However, the availability of resection tools is limited and comparative studies in the context of TORS are not available. In the context of the newest da Vinci Si HD® robotic system, various dissection methods were compared in a surgical animal model using porcine tongue at three different sites representing mucosal, muscular and lymphatic tissue. Resection methods included (a) CO2 laser tube, (b) flexible fiber Tm:YAG laser, (c) monopolar blade, and (d) radio frequency (RF) needle. Specimens were formalin-fixed, paraffin-embedded, cut, and stained with haematoxylin–eosin. Dissected tissue was examined for the width of the incision as well as the individual coagulation zone of each tool at various tissue sites. In addition, instrument costs and performance were determined. The incisions made by the RF needle had the most favourable cutting width and also smaller coagulation defects, as opposed to other tools, granting the best preservation of tumour-adjacent structures and improved pathological assessment. Instrument performance was best evaluated for CO2 laser and RF needle, whereas financial expenses were lowest for RF needle and monopolar blade. Improvement and modification of resection tools for TORS become a relevant criterion in order to facilitate routine usage in the surgical therapy of HNSCC. A consequent decrease in surgical mortality and improved precision of surgical tumour resection could lead to a significant clinical growth potential of TORS.

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References

  1. Adelstein DJ, Ridge JA, Brizel DM et al (2012) Transoral resection of pharyngeal cancer: summary of a National Cancer Institute Head and Neck Cancer Steering Committee Clinical Trials Planning Meeting, November 6-7, 2011, Arlington, Virginia. Head Neck 34:1681–1703

    Article  PubMed  Google Scholar 

  2. De Virgilio A, Park YM, Kim WS et al (2012) Robotic sialoadenectomy of the submandibular gland via a modified face-lift approach. Int J Oral Maxillofac Surg 41:1325–1329

    Article  PubMed  Google Scholar 

  3. Desai SC, Sung CK, Jang DW et al (2008) Transoral robotic surgery using a carbon dioxide flexible laser for tumors of the upper aerodigestive tract. Laryngoscope 118:2187–2189

    Article  PubMed  Google Scholar 

  4. Hinni ML, Salassa JR, Grant DG et al (2007) Transoral laser microsurgery for advanced laryngeal cancer. Arch Otolaryngol Head Neck Surg 133:1198–1204

    Article  PubMed  Google Scholar 

  5. Kang SW, Lee SC, Lee SH et al (2009) Robotic thyroid surgery using a gasless, transaxillary approach and the da Vinci S system: the operative outcomes of 338 consecutive patients. Surgery 146:1048–1055

    Article  PubMed  Google Scholar 

  6. Lee HS, Kim WS, Hong HJ et al (2012) Robot-assisted Supraomohyoid neck dissection via a modified face-lift or retroauricular approach in early-stage cN0 squamous cell carcinoma of the oral cavity: a comparative study with conventional technique. Ann Surg Oncol 19:3871–3878

    Article  PubMed  Google Scholar 

  7. Liboon J, Funkhouser W, Terris DJ (1997) A comparison of mucosal incisions made by scalpel, CO2 laser, electrocautery, and constant-voltage electrocautery. Otolaryngol Head Neck Surg 116:379–385

    Article  CAS  PubMed  Google Scholar 

  8. Ma G, Sano K, Ikeda H et al (1999) Promotional effects of CO(2) laser and scalpel incision on 4-NQO-induced premalignant lesions of mouse tongue. Lasers Surg Med 25:207–212

    Article  CAS  PubMed  Google Scholar 

  9. Matsumoto K, Suzuki H, Usami Y et al (2008) Histological evaluation of artifacts in tongue tissue produced by the CO2 laser and the electrotome. Photomed Laser Surg 26:573–577

    Article  PubMed  Google Scholar 

  10. Mattheis S, Mandapathil M, Rothmeier N et al (2012) Transoral robotic surgery for head and neck tumors: a series of 17 patients. Laryngorhinootologie 91:768–773

    Article  CAS  PubMed  Google Scholar 

  11. O’malley BW Jr, Quon H, Leonhardt FD et al (2010) Transoral robotic surgery for parapharyngeal space tumors. ORL J Otorhinolaryngol Relat Spec 72:332–336

    Article  PubMed  Google Scholar 

  12. O’malley BW Jr, Weinstein GS, Hockstein NG (2006) Transoral robotic surgery (TORS): glottic microsurgery in a canine model. J Voice 20:263–268

    Article  PubMed  Google Scholar 

  13. O’malley BW Jr, Weinstein GS, Snyder W et al (2006) Transoral robotic surgery (TORS) for base of tongue neoplasms. Laryngoscope 116:1465–1472

    Article  PubMed  Google Scholar 

  14. Remacle M, Matar N, Lawson G et al (2012) Combining a new CO2 laser wave guide with transoral robotic surgery: a feasibility study on four patients with malignant tumors. Eur Arch Otorhinolaryngol 269:1833–1837

    Article  PubMed  Google Scholar 

  15. Remacle M, Ricci-Maccarini A, Matar N et al (2012) Reliability and efficacy of a new CO2 laser hollow fiber: a prospective study of 39 patients. Eur Arch Otorhinolaryngol 269:917–921

    Article  PubMed  Google Scholar 

  16. Schoinohoriti OK, Chrysomali E, Iatrou I et al (2012) Evaluation of lateral thermal damage and reepithelialization of incisional wounds created by CO(2)-laser, monopolar electrosurgery, and radiosurgery: a pilot study on porcine oral mucosa. Oral Surg Oral Med Oral Pathol Oral Radiol 113:741–747

    Article  PubMed  Google Scholar 

  17. Sinha UK, Gallagher LA (2003) Effects of steel scalpel, ultrasonic scalpel, CO2 laser, and monopolar and bipolar electrosurgery on wound healing in guinea pig oral mucosa. Laryngoscope 113:228–236

    Article  PubMed  Google Scholar 

  18. Van Abel KM, Moore EJ, Carlson ML et al (2012) Transoral robotic surgery using the thulium:YAG laser: a prospective study. Arch Otolaryngol Head Neck Surg 138:158–166

    Article  PubMed  Google Scholar 

  19. Weinstein GS, O’malley BW Jr, Snyder W et al (2007) Transoral robotic surgery: supraglottic partial laryngectomy. Ann Otol Rhinol Laryngol 116:19–23

    PubMed  Google Scholar 

  20. Weinstein GS, O’malley BW Jr, Snyder W et al (2007) Transoral robotic surgery: radical tonsillectomy. Arch Otolaryngol Head Neck Surg 133:1220–1226

    Article  PubMed  Google Scholar 

  21. Zeitels SM, Burns JA, Akst LM et al (2006) Office-based and microlaryngeal applications of a fiber-based thulium laser. Ann Otol Rhinol Laryngol 115:891–896

    PubMed  Google Scholar 

  22. Zeitels SM, Kobler JB, Heaton JT et al (2006) Carbon dioxide laser fiber for laryngeal cancer surgery. Ann Otol Rhinol Laryngol 115:535–541

    PubMed  Google Scholar 

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Acknowledgments

The authors sincerely thank Tatjana Dudenhefter and Mario Amodio for surgical as well as Claudia Wacker for graphical assistance.

Conflict of interest

No conflicts of interest are declared.

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Authors and Affiliations

  1. Department of Otorhinolaryngology, University of Ulm, Frauensteige 12, 89070, Ulm, Germany

    Thomas K. Hoffmann, Patrick J. Schuler & Jens Greve

  2. Institute of Pathology and Neuropathology, University of Duisburg-Essen, Hufelandstr.55, 45147, Essen, Germany

    Agnes Bankfalvi

  3. Department of Otolaryngology, University of Duisburg-Essen, Hufelandstr.55, 45147, Essen, Germany

    Lukas Heusgen, Stephan Lang & Stefan Mattheis

  4. Department of Otolaryngology, University of Ulm, Frauensteige 12, 89075, Ulm, Germany

    Thomas K. Hoffmann

Authors
  1. Thomas K. Hoffmann
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  2. Patrick J. Schuler
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  3. Agnes Bankfalvi
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  4. Jens Greve
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  5. Lukas Heusgen
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  6. Stephan Lang
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  7. Stefan Mattheis
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Corresponding author

Correspondence to Thomas K. Hoffmann.

Additional information

T.K. Hoffmann and P.J. Schuler equally contributed to this work.

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Hoffmann, T.K., Schuler, P.J., Bankfalvi, A. et al. Comparative analysis of resection tools suited for transoral robot-assisted surgery. Eur Arch Otorhinolaryngol 271, 1207–1213 (2014). https://doi.org/10.1007/s00405-013-2615-9

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  • DOI: https://doi.org/10.1007/s00405-013-2615-9

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