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How I do it: transnasal retraction during transoral robotic oropharyngeal resection

  • Michael Gouzos
  • Neeraj Sethi
  • Andrew Foreman
  • Suren Krishnan
  • J. C. HodgeEmail author
Original Article
  • 62 Downloads

Abstract

Collapse of the resection plane presents a frustrating problem during transoral robotic resection, in a situation already typified by limited vision and access for instruments. We present a quick and cost-effective retraction technique to effectively mitigate this issue and increase the ease and reliability of robotic oropharyngeal resection. This technique utilises a simple transnasal apparatus to create greater exposure of the resection plane. A Y-suction catheter is inserted into the oropharynx via the nasal cavity. A silk suture is then used to attach it to the oropharyngeal resection specimen. When pulled from the nasal cavity, this apparatus adds a non-intrusive, tremor-free fixation point that pulls the resected specimen along a unique cephalo-posterior vector. This significantly improves access and vision of the desired dissection plane. The entire process takes approximately 1–2 min per side to properly execute. It can be adapted for various pathologies and subsites of the oropharynx. This transnasal technique is a simple, minimally invasive, and inexpensive method for improving wound tension during transoral oropharyngeal resection.

Keywords

Transoral robotic surgery Oropharynx Transnasal Retraction 

Notes

Funding

This study received no funding.

Compliance with ethical standards

Conflict of interest

Michael Gouzos declares that he has no conflict of interest. Neeraj Sethi declares that he has no conflict of interest. Andrew Foreman declares that he has no conflict of interest. Suren Krishnan has received educational grants from Intuitive Surgical™ and Medrobotics™. JC Hodge received educational grants from Intuitive Surgical™ and Medrobotics™.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Supplementary material

Supplementary material 1 (WMV 194901 KB)

Supplementary material 2 (MP4 8836 KB)

References

  1. 1.
    McLeod I, Mair E, Melder P (2005) Potential applications of the da Vinci minimally invasive surgical robotic system in otolaryngology. Ear Nose Throat J 84(8):483–487PubMedCrossRefGoogle Scholar
  2. 2.
    Hockstein NG, Nolan J, O’Malley BW Jr, Woo YJ (2005) Robot-assisted pharyngeal and laryngeal microsurgery: results of robotic cadaver dissections. Laryngoscope 115(6):1003–1008CrossRefPubMedGoogle Scholar
  3. 3.
    Vicini C, Dallan I, Canzi P, Frassineti S, Nacci A, Seccia V, Panicucci E, Grazia La Pietra M, Montevecchi F, Tschabitscher M (2012) Transoral robotic surgery of the tongue base in obstructive sleep Apnea-Hypopnea syndrome: anatomic considerations and clinical experience. Head Neck 34(1):15–22CrossRefPubMedGoogle Scholar
  4. 4.
    Moore EJ, Janus J, Kasperbauer J (2012) Transoral robotic surgery of the oropharynx: Clinical and anatomic considerations. Clin Anat 25(1):135–141CrossRefPubMedGoogle Scholar
  5. 5.
    Friedman M, Kelley K, Maley A (2013) Robotic glossectomy for obstructive sleep apnea technique. Oper Tech Otolaryngol-Head Neck Surg 24(2):106–110CrossRefGoogle Scholar
  6. 6.
    Miller M (2016) Tongue base exposure during TORS without the use of a mouth prop. J Robot Surg 10(4):347–352CrossRefPubMedGoogle Scholar
  7. 7.
    Weinstein G, O’Malley BE Jr, Snyder W, Sherman E, Quon H (2007) Transoral Robotic Surgery Radical Tonsillectomy. Arch Otolaryngol Head Neck Surg 133(12):1220–1226CrossRefPubMedGoogle Scholar
  8. 8.
    Cracchiolo JR, Roman BR, Kutler DI, Kuhel WI, Cohen MA (2016) Adoption of transoral robotic surgery compared with other surgical modalities for treatment of oropharyngeal squamous cell carcinoma. J Surg Oncol 114:405–411CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Hodge JC, Krishnan S, Rees G (2010) Transoral robotic surgery in the treatment of head and neck cancer patients: initial experience at the Royal Adelaide Hospital. Otolaryngol Head Neck Surg 143(5):S43–S44CrossRefGoogle Scholar

Copyright information

© Springer-Verlag London Ltd., part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Otolaryngology, Head and Neck SurgeryRoyal Adelaide HospitalAdelaideAustralia

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