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Tumori della testa e del collo pp 151–170Cite as

Nuove frontiere della chirurgia conservative: chirurgia laser e robot-assistita

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Riassunto

Se si esclude la chirurgia endoscopica nella patologia neoplastica benigna e maligna dei seni paranasali e del basicranio anteriore (che è oggetto di trattamento in un capitolo a parte), senza dubbio le più importanti recenti innovazioni tecnologiche in ambito oncologico otorinolaringoiatrico sono rappresentate dagli approcci transorali laser- e robotassistiti ai tumori delle alte vie aereo-digestive. Se i presupposti tecnologici di queste applicazioni erano già presenti rispettivamente alla fine degli anni ’70 e dalla meà degli ’80, è solo negli ultimi 15 anni per quanto riguarda il laser e negli ultimi 5 per la chirurgia robotica, che queste modalità terapeutiche sono state precisamente codificate, applicate e diffuse anche al di fuori di un ristretto numero di centri. Al di là della possibilità materiale di disporre di certi strumenti, in questo ambito ha svolto un ruolo decisivo il superamento (così in ambito orofaringo-ipofaringo-laringeo come nel distretto naso-sinusale) del preesistente dogma dell’exeresi tumorale en bloc. Se, corne sembra, la rimozione di una neoplasia endocavitaria con tecnica piece meal non inficia la radicalità loco-regionale, allora risulta concettualmente possibile procedere alla rimozione attraverso aperture fisiologiche come il cavo orale, lavorando in spazi estremamente ristretti, fisiologicamente inaccessibili alle mani del chirurgo. Di qui l’applicazione di strumenti che consentono il taglio, il coagulo e la rimozione di tessuto con tecnica hand off (come con il laser a CO2, il cui raggio luminoso parte al di fuori del laringoscopio e non ne occupa alcuna porzione, come si vedrà in seguito) oppure di sostituti miniaturizzati delle mani del chirurgo (in grado di essere controllate a distanza e di potenziarne le capacità motorie, come nel caso del robot). Il tutto è reso ancora più preciso da una visualizzazione (microscopica per il laser, endoscopica binoculare e tridimensionale per il robot) migliore di quella dell’occhio nudo o delle loops chirurgiche tradizionalmente impiegate negli approcci a cielo aperto.

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  1. Clinica Otorinolaringoiatrica, Università degli Studi di Brescia, Brescia, Italia

    Cesare Piazza

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  1. Cesare Piazza
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  2. Francesca Del Bon
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  3. Piero Nicolai
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  4. Giorgio Peretti
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Piazza, C., Del Bon, F., Nicolai, P., Peretti, G. (2011). Nuove frontiere della chirurgia conservative: chirurgia laser e robot-assistita. In: Tumori della testa e del collo. Springer, Milano. https://doi.org/10.1007/978-88-470-1806-8_11

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