H&N Robotic Surgery Update. April 29, 2023

What´s new in PubMed this week

Rogalska M, Antkowiak L, Kasperczuk A, Scierski W, Misiolek M. Transoral Robotic Surgery in the Management of Submandibular Gland Sialoliths: A Systematic Review. J Clin Med. 2023 Apr 20;12(8):3007. doi: 10.3390/jcm12083007. PMID: 37109343

A group of colleagues from Poland systematically review the published data on the management of submandibular gland stones. Most of the cases were performed in different temporal combinations with sialoendoscopy. The main concern, of course is the lingual nerve. ¿Results? Transient injury in 23,8% of cases; no permanent injury. The technique is an additional option for submandibular gland preservation.

Ngo DQ, Van Pham B, Ngo QX, Van Le Q. Three-port transoral robotic thyroidectomy without axillary incision: A preliminary report on a case series from Vietnam. Int J Med Robot. 2023 Apr 27:e2521. doi: 10.1002/rcs.2521. Epub ahead of print. PMID: 37104708.

Colleagues from Vietnam present their early experience (5 first cases) with TransOral Robotic Thyroidectomy (TORT). With or without robotic assistance, the transoral / transvestibular approach to the neck is clearly expanding worldwide.

Chen W, Kalia M, Zeng Q, Pang EHT, Bagherinasab R, Milner TD, Sabiq F, Prisman E, Salcudean SE. Towards transcervical ultrasound image guidance for transoral robotic surgery. Int J Comput Assist Radiol Surg. 2023 Apr 27. doi: 10.1007/s11548-023-02898-y. Epub ahead of print. PMID: 37103728

One of the most promising areas for development in remote surgery is the integration of Augmented Reality (AR). Possibilities are plenty and research intense. This group from Canada proposes ultrasound image guidance. The great difference with current navigation tools (based on CT or MRI previous data) is that ultrasound is real time.

Allen DZ, Gorelik D, Butler EB, Zhang J, Kain JJ. Single-port transoral robotic surgery for a rare tonsil mass. J Surg Case Rep. 2023 Apr 19;2023(4):rjad197. doi: 10.1093/jscr/rjad197. PMID: 37090905; PMCID: PMC10115462

A case report from Texas. Lateral oropharyngectomy with da Vinci Xi SP. Unusual pathology: sarcoma. Many of us are looking forward to use the Single Port (SP) for TORS and Remote Access to the neck.

Shah SB, Chawla R, Kaur C. Assessment of stress response due to C-Mac D-blade guided videolaryngoscopic endotracheal intubation and docking of da Vinci surgical robot using perfusion index in patients undergoing transoral robotic oncosurgery. J Clin Monit Comput. 2023 Apr 24. doi: 10.1007/s10877-023-01005-5. Epub ahead of print. PMID: 37088851

I have to confess I do love the C-Mac. I am using it more and more for exploration and biopsy of the upper airway. This is an interesting approach to evaluate surgical stress. But about the FKWO pharyngolaryngoscope retractor, please do not forget the “W” and the “O”. Greg Weinstein and Bert O´Malley modified the original old design by Feyh and Kastenbauer (FK) and this modifications, particularly the new blades, have been critical for the development of TORS worldwide. Now it is the least bad device we have for transoral robotic approach. But it is still quite aggressive. Want to know more?

Nishikawa D, Beppu S, Suzuki H, Terada H, Sawabe M, Hanai N. A novel technique in transoral robotic surgery: A case report of rotating and switching technique. Int J Med Robot. 2023 Apr 22:e2520. doi: 10.1002/rcs.2520. Epub ahead of print. PMID: 37086451

A do not see the point. Certainly computer assisted remote surgery allows this adjustments, but the usual surgical field is comfortable enough. Why invert the surgical field to an anti-gravitational image? Also there must be a mistake: the base of the tongue with 0º endoscope? For sure there is a misunderstanding with this Japanese colleagues.

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