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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_4451_Библиотеки_им_академика_М_И_Перельмана
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Transoral Robotic Surgery
https://t.me/medicina_free
293
(TORS) may result in improved swallowing outcomes and reduced rates of tracheotomies (CRT).
At specic time points, TORS may possibly be
linked to superior speech results when compared
to adjuvant CRT or radiation (RT).
According to numerous studies, TORS may
also be helpful for locating and treating unknown
primary tumours in the head and neck, with a primary detection rate of 53–78% and a positive surgical margin rate of 19.4% [6]. When patients
have negative results from a physical examination, diagnostic imaging and positron emission
tomography (PET), TORS or transoral laser
microsurgery (TLM) may be especially helpful
for nding occult primary tumours.
TORS has been utilised for supraglottic laryngectomy with satisfactory functional results, but
there is limited data on its usage for total laryngectomy or glottic malignancy. With the proper
neck dissection, TORS might be an effective primary therapy option for early hypopharyngeal
carcinoma. The use of TORS for thyroid surgery
is still in its infancy and needs more development, standardisation and oncological result and
safety testing. The use of remote access procedures for thyroid surgery has reduced due to concerns about patient candidacy, safety and resource
use. In specialised clinics, robotic-assisted thyroid surgery is still in its infancy, but there is a
market for it among patients who value its aesthetic advantages.
2 Contraindications forTORS
restricted access to the area being treated. For
some types of advanced cancer, neck conditions
that cannot be surgically treated and numerous
distant metastases, TORS may not be advised.
Medical comorbidities that preclude a patient
from receiving general anaesthesia, trismus that
restricts access to the oral cavity and cervical
spine illness that prevents the patient from assuming the proper position are all non-oncological
contraindications to TORS.
There are various limitations to adopting
robotic surgery, including cost-effectiveness, loss
of tactile sense and the necessity for haptic feedback between the operator and the machine.
Many towns nd it nancially unviable due to the
expensive cost of the equipment and the uncommon usage of otolaryngologic equipment in the
neck. The camera’s better visual information can
somewhat make up for the loss of touch sensibility, but haptic feedback is still necessary for precise surgery [7].
For the treatment of oropharyngeal and supraglottic laryngeal malignancies, transoral robotic
surgery (TORS) has been proven to have high
functional results and low tracheotomy rates.
Additionally, it might be helpful for the detection
and management of unidentied primary tumours
as well as thyroid disorders. For the best results,
cases should be carefully chosen because TORS
may not be appropriate for all patients. The price
of TORS and the surgeon’s lack of tactile perception place restrictions on its use. TORS has a
wide range of potential applications, and as technology advances, so may its pricing.
TORS may not be used if a patient has certain
contraindications, such as trismus (restricted jaw
movement), specic tumour sites or sizes or other
medical disorders that may render a patient unt
for general anaesthesia. Preoperative imaging
can help pinpoint the tumour’s position, size and
extent as well as any anatomical traits that might
have an impact on the operation’s outcome. The
distance from the posterior pharyngeal wall to the
hyoid bone, the angle between the epiglottis and
the vertical plane of the larynx and the distance
from the posterior pharyngeal wall to the soft palate are additional markers that can suggest
References
1. Ansarin M, Zorzi S, Massaro MA, Tagliabue M,
Proh M, Giugliano G, et al. Transoral robotic sur-
gery vs transoral laser microsurgery for resection of
supraglottic cancer: a pilot surgery. Int J Med Robot.
2014;10(1):107–12.
2. Hockstein NG, Gourin CG, Faust RA, Terris DJ.A
history of robots: from science ction to surgical
robotics. J Robot Surg. 2007;1(2):113–8.
3. Alicandri-Ciufelli M, Bonali M, Piccinini A, Marra L,
Ghidini A, Cunsolo EM, etal. Surgical margins in head
and neck squamous cell carcinoma: what is “close”?
Eur Arch Otorhinolaryngol. 2013;270(10):2603–9.
294
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K. N. Rao et al.
4. Weinstein GS, O’Malley BW Jr, Cohen MA, Quon
H. Transoral robotic surgery for advanced oropharyngeal carcinoma. Arch Otolaryngol Neck Surg.
2010;136(11):1079–85.
5. Haughey BH, Hinni ML, Salassa JR, Hayden RE,
Grant DG, Rich JT, etal. Transoral laser microsurgery
as primary treatment for advanced-stage oropharyn-
geal cancer: a United States multicenter study. Head
Neck. 2011;33(12):1683–94.
6. Rao KN, Gangiti KK. Transoral robotic surgery.
Indian J Surg Oncol. 2021;12(4):847–53.
7. Okamura AM. Haptic feedback in robot-assisted
minimally invasive surgery. Curr Opin Urol.
2009;19(1):102–7.
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