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How to optimize laryngeal and hypopharyngeal exposure in transoral robotic surgery

 Armando De Virgilio  ;  Young Min Park  ;  Won Shik Kim  ;  Seung Jae Baek  ;  Se-Heon Kim 
 AURIS NASUS LARYNX, Vol.40(3) : 312-319, 2013 
Journal Title
Issue Date
Aged ; Female ; Humans ; Hypopharyngeal Neoplasms/surgery* ; Laryngeal Neoplasms/surgery* ; Male ; Muscle Relaxants, Central/therapeutic use ; Otorhinolaryngologic Surgical Procedures/methods* ; Preoperative Care ; Prospective Studies ; Robotics* ; Surgical Instruments ; Tracheotomy
Transoral robotic surgery ; Exposure ; Larynx ; Hypopharynx
OBJECTIVE: The aim of this study was to present the various strategies adopted in our center to improve and overcome problems with exposure of the operative field in 48 patients who underwent TORS for the treatment of laryngeal and hypopharyngeal cancer. METHODS: We present our operative and preoperative treatment protocols for patients undergoing TORS for laryngeal and hypopharyngeal cancer. In particular, we emphasize the role of preoperative exposure assessment and the usefulness of simple measures to overcome problems with exposure of the operative field. RESULTS: In 12 patients (25%), we experienced difficult laryngeal-hypopharyngeal exposure. However the correct positioning of the robotic arms, the proper use of the laryngeal and tongue blade and some simple maneuvers, such as the anterior traction of the tongue and the partial epiglottectomy, ensured the feasibility of TORS with negative margins in all patients. CONCLUSION: In TORS, the exposure of larynx and hypopharynx can be difficult, but the adoption of certain methods may make it possible in most patients. An accurate preoperative evaluation under general anesthesia is the primary strategy for reducing the number of cases terminated intraoperatively. Currently, TORS is not feasible in all patients, but in our opinion, reductions in the size of robotic equipment and development of new devices will extend the application of TORS to a larger number of patients.
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1. College of Medicine (의과대학) > Dept. of Otorhinolaryngology (이비인후과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Se Heon(김세헌)
Kim, Won Shik(김원식)
Park, Young Min(박영민) ORCID logo https://orcid.org/0000-0002-7593-8461
Baek, Seung Jae(백승재)
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