1,721,014 research outputs found
Transoral Robotic Surgery for Obstructive Sleep Apnea: Past, Present, and Future
No full textNocturnal upper airway collapse often involves the obstruction at the tongue base. Several surgical procedures have been developed in recent years to address this area in continuous positive airway pressure-nonadherent patients and include hyolingual advancement, tongue suture suspension, and various lingual resection techniques. Traditional tongue base resection is generally done either via a transcervical technique or transorally with an endoscope for visualization. Each of these approaches has significant potential limitations. The unsurpassed visualization, dexterity, and control provided by the Da Vinci Surgical System offer many benefits for the surgeon compared with the other technologies
Tips and tricks in transoral robotic surgery for challenging vascular tumors
No full textSurgical removal of head-neck vascular neoplasms may have severe complications, although surgery remains a very important treatment modality. One of the most important aspects is to avoid the rupture of the tumor's capsule and to minimize functional complications, especially in the excision of benign tumors. The transoral robotic surgery allows removing lesions in challenging anatomical areas. Furthermore, the current robotic instrumentation does not allow a fine dissection of the structures and capsule rupture is a potential event. Here, the authors describe a minimally invasive technique using transoral robotic surgery for removal of vascular tumors in head-neck. Particular attention was given to the description of the diagnostic work up, the preoperative assessment and the surgical steps. No complications were encountered postoperatively. Transoral robotic surgery for vascular tumors appears to be a safe and feasible technique with minimal complications
Transoral Robotic Surgery (TORS) for Bilateral Eagle Syndrome
No full textEagle syndrome is a rare and poorly understood clinical condition caused by an elongated or disfigured styloid process. The possible managements of Eagle syndrome include conservative medical treatment or surgical intervention. The surgical removal of the elongated styloid process may be efficiently achieved either by an intraoral or a transcervical approach. An effective styloidectomy may be either total or partial, provided the bony residue's length is within the range of normality. Here, we report our experience with a bilateral robotic-assisted styloidectomy in a young female patient. Our experience showed that this procedure is a safe alternative to traditional surgical approaches, granting an excellent view and a safe manipulation by robotic arms, and, thereby, avoiding iatrogenic damage to neurovascular structures. Moreover, transoral robotic surgery could represent the gold standard for the treatment of bilateral Eagle syndrome cases allowing a quick and safe single-time surgery
Transoral robotic surgery: Tongue base reduction and supraglottoplasty for obstructive sleep apnea
No full textA transoral robotic version of Chabolle's tongue base reduction with hyoid epiglottoplasty for obstructive sleep apnea syndrome is described. The main tongue base and supraglottic surgical steps are pointed out, as well as the indications and potential complications. The advantages and limits of this minimally invasive approach are discusse
The temporalis muscle flap for reconstruction of soft palate and lateral oropharyngeal wall after transoral robotic surgery
No full textTrans Oral Robotic Surgery (TORS) is a prominent surgical approach for the resection of oropharyngeal tumors without division of the lip and mandible. Some defects following TORS are large and complex enough to benefit soft-tissue coverage. The pedicled temporalis muscle flap is a versatile and reliable flap and may be a valid option to reconstruct defects of the lateral pharyngeal wall and partial soft palate
Successful application of transoral robotic surgery in failures of traditional transoral laser microsurgery: Critical considerations
No full textAims: To assess the role of transoral robotic surgery (TORS) in managing failures of conventional transoral laser microsurgery (TLM) in cases with difficult laryngeal exposure. Methods: Retrospective analysis of 3 patients with difficult laryngeal exposure treated with TORS. All 3 cases failed to be managed by conventional TLM after repeated attempts by experienced surgeons. In 2 cases, the initial disease was laryngeal cancer treated by a cricohyoidoepiglottopexy, with an obstructing residual epiglottis. The last case was a bilateral Reinke disease submitted to repeated TLM procedures, producing multiple supraglottic and glottic scars. In all cases, the difficult exposure was produced by a combination of concurrent elements including insufficient mouth opening, short and stiff neck, macroglossia and high-positioned larynx. Results: Two patients were exposed by means of a Davis Meyer mouth gag. The other patient was managed by a Feyh-Kastenbauer device. The key of the success was the possibility to work 'around the corner' (30° angle view) where straight alignment of the larynx was impossible. Conclusions: Where possible, a TORS approach should be considered complementary to TLM in cases of very difficult or even impossible conventional transoral laryngoscopic approach. © 2014 S. Karger AG, Basel
New non-invasive electrical stimulation devices for treatment of snoring and obstructive sleep apnoea: a systematic review
No full textIntroduction: Recently, new non-invasive electrical stimulation devices have been developed with the aim to increase the tongue muscle tone for patients with obstructive sleep apnoea (OSA) and snorers. The aim of this study was to provide a review of the first results found in the literature regarding the efficacy of non-invasive electric stimulation devices for the treatment of primary snoring and OSA. Material and Methods: An electronic search was performed on PubMed/MEDLINE, Google Scholar, and Ovid databases. The PRISMA statement was followed. Databases were searched from inception through September, 2021. Results: Four studies met the criteria for inclusion in this review, for a total of 265 patients. Two devices were included in this review, Apone-Stim 400 Muscle Stimulator and eXciteOSA. All studies suggested that these new devices are effective in improving snoring by approximately 50% after device training, without major complications. However data regarding OSA improvement are conflicting. Conclusions: Intraoral non-invasive electrical stimulation devices can be considered a valid option to current therapies for snoring. Further studies are needed to support these interesting new devices for treatment of OSA
The temporalis muscle flap for reconstruction of soft palate and lateral oropharyngeal wall after transoral robotic surgery
No full textTrans Oral robotic surgery (TORS) is a prominent surgical approach for the resection of oropharyngeal tumors without division of the lip and mandible. The current practice following TORS is to allow the defect to heal by secondary intention, but some defects following TORS are large and complex enough to benefit soft-tissue coverage. In the free flap era, regional flaps are often overlooked albeit they still represent a valid alternative. In terms of cost-effectiveness, the use of alternative pedicled flaps in TORS framework probably reduced the risks of postoperative complications, with consequent expenditure restraints and reducing treatment costs arising from operating room duration and double surgical team. In this report we described the successfully use of the pedicled temporalis muscle flap for the reconstruction of the soft palate and lateral pharyngeal wall following TORS. This versatile and reliable flap may be a valid option in TORS framework
Trans-oral robotic surgery (TORS) for the treatment of lingual tonsillitis. When conventional therapies fail
No full textBackground: Lingual tonsillitis is an underestimated but serious health problem. This paper describes the feasibility and efficacy of the trans-oral robotic surgical approach in cases of lingual tonsillitis. Materials and Methods: From February 2012 to April 2014, 10 patients affected by lingual tonsillitis resistant to medical treatments underwent transoral robotic lingual tonsillectomy at the authors’ Institution. Results: The surgical robotic procedure was completed in all cases and there was no need to change the operative approach once started. The mean set-up time was 13.2 ± 5.2 min, while mean operating time was 28 ± 12 min. The mean amount of tissue removed was 16.5 ± 13 cm3. No major intra-operative and post-operative complications were registered. After 15.2 ± 12 months of follow-up, no relapses were reported and patients did not complain of any further symptoms. Conclusion: Lingual tonsillitis seems to be safely and effectively managed by trans-oral robotic surgery. The data are encouraging and worthy of further evaluation. Copyright © 2016 John Wiley & Sons, Ltd
Swallowing outcome after TORS for sleep apnea: short- and long-term evaluation
No full textThe aim of this study was to evaluate outcomes related to swallowing function in patients who underwent transoral robotic surgery (TORS) for sleep apnea on both short- and long-term scales. 78 patients who underwent TORS for sleep apnea between 2011 and 2014 were followed up for an average period of 20 ± 7.12 months (range 7â32 months), then swallowing outcomes determined by MD Anderson Dysphagia Inventory (MDADI) questionnaire, gastrografin fluoroscopy imaging results, nasogastric tube dependence and subjectively by recording the patientsâ complaints were analyzed and reported. Minimal insignificant short-term impact on swallowing function (4.58 ± 7.03 preoperative MDADI score versus 5.18 ± 8.32 post-operative) (p = 0.56) was registered. Mean time for start of oral feeding was 1.05 ± 0.25 days (average, 1â3). In no case nasogastric tube feeding was required. Only five patients (6 %) showed significant aspiration on gastrografin fluoroscopy examination after 1 week; there was no significant correlation between the volume of tissue removed from both tongue base and epiglottis to the incidence of aspiration as shown by gastrografin fluoroscopy examination (p = 0.72). No long-term swallowing complaint was registered. Patients who underwent TORS tongue base reduction and supraglottoplasty for sleep apnea proved to have a reasonable short-term swallowing outcomes with no long-term sequelae
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