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Transoral robotic surgery (TORS) for base of tongue neoplasms
Bert W O'Malley1, Gregory S Weinstein, Wendy Snyder
1Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA. bert.omalley@uphs.upenn.edu
Objective:
To develop a minimally invasive surgical technique for the treatment of base of tongue neoplasms using the optical and technical advantages of robotic surgical instrumentation.
Study Design:
Ten experimental procedures including tongue base exposure and dissections were performed on three cadavers and two mongrel dogs. Transoral robotic surgery (TORS) was then performed on three human patients with tongue base cancers in a prospective human trial.
Methods:
Using the da Vinci Surgical Robot (Intuitive Surgical, Inc., Sunnyvale, CA), we performed a total of 10 base of tongue resections on edentulous and dentate cadavers as well as live mongrel dogs. In the cadaver models, exposure was evaluated using three different retractors, the Dingman, Crowe Davis, and FK retractors. The three human patients underwent TORS surgery of their tongue base cancers under an institutional review board approved prospective clinical trial. The ability to identify and preserve or resect key anatomic structures such as the glossopharyngeal, hypoglossal, and lingual nerves as well as techniques for identifying the lingual artery and achieving hemostasis were developed.
Results:
The da Vinci Surgical Robot provided excellent visualization and enabled removal of the posterior one third to one half of the oral tongue in cadavers, dogs, and human patients. Among the three retractors evaluated, the FK retractor offered the greatest versatility and overall exposure for robotic instrument maneuverability. Complete resection to negative surgical margins with excellent hemostasis and no complications was achieved in the live patient surgeries.
Conclusions:
TORS provided excellent three-dimensional visualization and instrument access that allowed successful surgical resections from cadaver models to human patients. TORS is a novel and minimally invasive approach to tongue neoplasms that has significant advantages over classic open surgery or endoscopic transoral laser surgery.
Insights
Transoral robotic surgery (TORS) offers a minimally invasive approach for base of tongue neoplasms. This technique provides excellent visualization and instrument access, enabling successful tumor resection with clear margins.
Area of Science:
- Surgical Oncology
- Robotic Surgery
- Head and Neck Surgery
Background:
- Base of tongue neoplasms present surgical challenges.
- Minimally invasive techniques are sought to improve outcomes.
Purpose of the Study:
- To develop and evaluate transoral robotic surgery (TORS) for base of tongue neoplasms.
- To leverage robotic instrumentation for enhanced visualization and access.
Main Methods:
- Experimental procedures on cadavers and dogs for technique development.
- Prospective clinical trial involving three human patients with tongue base cancers.
- Utilized the da Vinci Surgical Robot for resections and evaluated retractor effectiveness.
Main Results:
- The da Vinci Surgical Robot provided excellent 3D visualization and enabled resection of significant portions of the oral tongue.
- The FK retractor demonstrated superior versatility and exposure for robotic instruments.
- Complete tumor resection with negative margins, excellent hemostasis, and no complications in human patients.
Conclusions:
- TORS is a viable, minimally invasive surgical option for base of tongue neoplasms.
- Offers significant advantages in visualization and instrument maneuverability over traditional methods.
- Successful application demonstrated from cadaveric studies to clinical patient care.
