Selective embolization of lingual artery in transoral robotic surgery for the management of recurrent base of tongue carcinomas

Head & Neck ◽  
2020 ◽  
Author(s):  
Vishal U. S. Rao ◽  
Anand Subash ◽  
Vidya Bhargavi ◽  
Piyush Sinha ◽  
Ritvi K. Bagadia ◽  
...  
Keyword(s):  
Robotic Surgery ◽  
Transoral Robotic Surgery ◽  
Lingual Artery ◽  
Selective Embolization ◽  
Base Of Tongue

scholarly journals 0659 A Safe and Precise Tongue Base Surgery for Obstructive Sleep Apnea: Real-Time Intraoperative Ultrasound-Assisted Transoral Robotic Surgery

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A251-A252
Author(s):  
C Lin ◽  
C Chang ◽  
J Hsiao ◽  
J Wu ◽  
H Tsai
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Robotic Surgery ◽  
Intraoperative Ultrasound ◽  
Transoral Robotic Surgery ◽  
Tongue Base ◽  
Assessment Tools ◽  
Bleeding Complications ◽  
Lingual Artery ◽  
Obstructive Sleep

Abstract Introduction Lingual artery (LA) injury is a devastating complication of tongue base surgery. Compared with the anatomic findings of computed tomography angiography (CTA), intraoperative blade of mouth gag might change the thickness of base of tongue (BOT) and anatomy of LA. We aimed to investigate the position of LA in the BOT with intraoperative ultrasound (IOU) imaging during transoral robotic surgery (TORS), and evaluate the bleeding complications when assisted with / without IOU. Methods Adult obstructive sleep apnea (OSA) patients who received TORS in BOT resection were recruited since 2016. Assessment tools were pre-op over-night hospital polysomnography (PSG) and anatomy-based Friedman Staging System. Ultrasound imaging was utilized to identify anatomic parameters of LA in BOT, including distance to midline, arterial depth and diameter. Results Ninety-three OSA patients (82 male, 88.2%) were analyzed. The mean age was 42.2±10.0 years old and body mass index was 29.2±4.5 kg/m2. The average apnea hypopnea index (AHI) was 58.1±21.4 events/hour. There were 66 (71.0%), 24 (25.8%) and 3 (3.2%) patients in Friedman stages II, III and IV, respectively. Seventy patients underwent TORS with IOU had shorter operation time (191.7±3.8 minutes) than 23 patients without IOU (220.1±6.6 minutes), less total blood loss (11.3±10.8 versus 19.6±26.7 ml), and more BOT tissue reduction volume (7.1±2.5 versus 3.9±1.6 ml). Significant predictors of arterial depth were higher AHI level during rapid-eye-movement (REM) sleep stage (p=0.038), bigger tonsil size (p=0.034) and more elevated Friedman tongue position (p=0.012). Postoperative complication associated with LA injury was not found in the patients with use of IOU. Conclusion When tongue retracted with blade, the distance to midline and depth of LA were altered in BOT. With IOU assisted, surgeon could identify LA position confidently. It is expectable to maximize efficiency and minimize catastrophic bleeding complications when OSA patients received TORS in BOT resection. Support nil

Transoral Robotic Surgery (TORS) for Base of Tongue Neoplasms

2006 ◽  
Vol 116 (8) ◽  
pp. 1465-1472 ◽  
Author(s):  
Bert W. O??Malley ◽  
Gregory S. Weinstein ◽  
Wendy Snyder ◽  
Neil G. Hockstein
Keyword(s):  
Robotic Surgery ◽  
Transoral Robotic Surgery ◽  
Base Of Tongue ◽  
Tongue Neoplasms

scholarly journals Transoral robotic surgery for the benefit of patients with head and neck cancer of unknown primary: our experience at St George’s University Hospital, London

2020 ◽  
Vol 102 (6) ◽  
pp. 442-450
Author(s):  
R Mistry ◽  
A Walker ◽  
D Kim ◽  
E Ofo
Keyword(s):  
Robotic Surgery ◽  
Head And Neck ◽  
Primary Tumour ◽  
Head And Neck Carcinoma ◽  
Transoral Robotic Surgery ◽  
Unknown Primary ◽  
Carcinoma Of Unknown Primary ◽  
Identification Rate ◽  
Base Of Tongue ◽  
Neck Carcinoma

Introduction Head and neck carcinoma of unknown primary represents 1–5% of all head and neck cancers and presents a diagnostic and therapeutic dilemma. In approximately 40% of cases, a primary tumour location remains unknown despite investigation. With advancements in our understanding of the role of high-risk human papilloma virus in head and neck cancer, transoral robotic surgery presents an option for diagnosis and therapy. Materials and methods This is a retrospective case series from a single centre. Case notes were reviewed for 28 patients who had transoral robotic surgery for head and neck carcinoma of unknown primary between May 2015 and July 2019. Results Transoral robotic surgery identified an oropharyngeal primary tumour in 19 of 28 (67.8%) patients. All oropharyngeal primaries were p16 positive. The base of tongue identification rate was 63.2%. Median length of inpatient stay postoperatively was 1.0 day. Normal oral intake resumed within 48 hours in 96% (27/28) of patients. Three patients (10.3%) suffered minor postoperative bleeds that were all managed conservatively. Discussion The base of tongue primary identification rate (63.2%) in this series is consistent with that previously reported (43–63%; 95% confidence interval). Primary tumour identification rate if a patient is p16 positive is 86.3% (19/22), with 100% of these being oropharyngeal. We suggest future investigation into p16 status as a means of stratifying patients with head and neck carcinoma of unknown primary for transoral robotic surgery. Conclusion Transoral robotic base of tongue mucosectomy (or lingual tonsillectomy) is a promising technique that offers a high yield of positive identification for the primary tumour. It is well tolerated with minimal associated morbidity. Our findings are comparable with those in the current literature.

scholarly journals Large volume haemorrhage following transoral robotic surgery (TORS) as a result of fibromuscular dysplasia: first reported case

2019 ◽  
Vol 12 (11) ◽  
pp. e232022
Author(s):  
Samuel Robert Leedman ◽  
Aaron Esmaili ◽  
Tejinder Singh ◽  
Desmond Wee
Keyword(s):  
Robotic Surgery ◽  
Fibromuscular Dysplasia ◽  
Good Health ◽  
Transoral Robotic Surgery ◽  
Lingual Artery ◽  
Haemorrhagic Complication ◽  
Intensive Care Admission ◽  
Severe Haemorrhage ◽  
Aneurysmal Dilation ◽  
Central Base

We present a case of a 61-year-old woman who suffered a haemorrhagic complication of an aneurysmal left lingual artery, secondary to fibromuscular dysplasia, following transoral robotic surgery (TORS). She was admitted through the emergency department 3 days after resection of a central base of tongue tumour. She suffered a massive haemorrhage requiring intensive care admission, blood transfusion, intubation, operative and endovascular intervention. The diagnosis of fibromuscular dysplasia was made at angiography. During attempts to embolise the culprit left lingual artery, the vessel dissected at its origin leading to arrest of bleeding. Repeat angiograms during her admission demonstrated unchanged appearances and ruled out recanalisation of the vessel. She was extubated and remained stable on the ward, discharged home some days later in good health. To our knowledge, this is the first ever reported case of fibromuscular dysplasia affecting the lingual artery leading to aneurysmal dilation and severe haemorrhage following TORS.

Intraoral midline mandibulotomy to improve access for transoral robotic surgery (TORS) base of tongue resection in a retrognathic and microstomic patient

2020 ◽  
Vol 13 (10) ◽  
pp. e236010
Author(s):  
Daniel Bestourous ◽  
Margaret Michel ◽  
Christopher Badger ◽  
Punam Thakkar ◽  
Arjun S Joshi
Keyword(s):  
Robotic Surgery ◽  
Plate Fixation ◽  
Cell Cancer ◽  
Nuclear Imaging ◽  
Neck Mass ◽  
Transoral Robotic Surgery ◽  
Unknown Primary ◽  
Tumour Resection ◽  
Cervical Lymph Nodes ◽  
Base Of Tongue

A 74-year-old man was referred to a tertiary academic otolaryngology clinic for evaluation of a left-sided neck mass with unknown primary. Nuclear imaging modalities revealed a primary cancer located at the left tongue base. Further investigation revealed the tumour to be a p16 positive squamous cell cancer with metastatic spread to cervical lymph nodes of multiple levels. The patient was found on initial investigation to have microstomia and a retrognathic mandible, which are typically considered unsuitable for robotic surgery due to difficulties obtaining adequate exposure.The patient underwent bilateral neck dissection, followed by transoral robotic-assisted left base of tongue resection. A midline intraoral mandibulotomy was performed to improve robotic access. Following tumour resection, the mandible was repaired using open reduction with internal plate fixation. Postoperative occlusion was maintained, and the patient recovered well from mandibulotomy with none of the morbidity or cosmetic defects associated with a traditional lip-split approach.

Sign in / Sign up

Export Citation Format

Share Document