Nuances and Management of Hilar Submandibular Sialoliths With Combined Transoral Robotic Surgery–Assisted Sialolithotomy and Sialendoscopy

Objective To describe the management, technical nuances, and success rates of transoral robotic surgery (TORS)–assisted sialolithotomy. Study Design Retrospective database review. Setting Quaternary academic medical center. Methods Between the months of January 2015 and May 2019, patients with hilar submandibular gland stones underwent 2 main variations of TORS-assisted sialolithotomy and sialendoscopy: (1) TORS followed by sialendoscopy for patients with palpable predominantly single stones and (2) either sialendoscopy followed by TORS and sialendoscopy or sialendoscopy followed by TORS only for patients with nonpalpable or multiple stones. Clinical charts were reviewed to collect data, including stone size (imaging review, intraoperative measurement), palpability, duration of operation, TORS variation, operative challenges, symptom improvement, gland preservation rate, and complications. Results Thirty-seven patients were identified. Patients were 26 to 80 years old (mean, 57.2 years), and 40.5% were female. Twenty-four patients (64.9%) underwent TORS followed by sialendoscopy; 10 (27.0%), sialendoscopy followed by TORS and sialendoscopy; and 3 (8.1%), sialendoscopy followed by TORS only. The mean stone size was 12.4 mm (range, 4-28 mm). Eleven patients had multiple stones with a mean 4 stones per patient (range, 2-9). Procedural success was 91.9% (34/37) at a mean follow-up of 34.2 weeks (range, 1.4-262.1), and the gland preservation rate was 97.3% (36/37). No patients reported symptoms of lingual nerve injury at 3-month follow-up. Conclusion TORS combined with sialendoscopy for hilar submandibular gland sialolithiasis allows for improved visualization of critical anatomy, tissue manipulation, and operative flexibility. In our experience, the operative success rate is high, and duration of surgery compares favorably with conventional combined hilar approaches.

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Revisiting the Recommendation for Contralateral Tonsillectomy in HPV-Associated Tonsillar Carcinoma

Otolaryngology ◽

10.1177/0194599820968800 ◽

2020 ◽

pp. 019459982096880

Author(s):

Harman S. Parhar ◽

David Shimunov ◽

Robert M. Brody ◽

Steven B. Cannady ◽

Jason G. Newman ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Robotic Surgery ◽

Cell Carcinoma ◽

Locoregional Recurrence ◽

Transoral Robotic Surgery ◽

Survival Outcomes ◽

Second Primary ◽

Unilateral Disease ◽

Second Primaries

Objective Despite epidemiologic evidence that second primaries occur infrequently in HPV (human papillomavirus)–associated oropharyngeal squamous cell carcinoma, recent recommendations advocate for elective contralateral palatine tonsillectomy. We aimed to study this discordance and define the necessary extent of up-front surgery in a large contemporary cohort with long-term follow-up treated with unilateral transoral robotic surgery. We hypothesized that second primaries are discovered exceedingly rarely during follow-up and that survival outcomes are not compromised with a unilateral surgical approach. Study Design Retrospective cohort analysis. Setting Tertiary care academic center between 2007 and 2017. Methods Records for patients with p16-positive oropharyngeal squamous cell carcinoma of the tonsil and workup suggestive of unilateral disease who underwent ipsilateral transoral robotic surgery were analyzed for timing and distribution of locoregional recurrence, distant metastases, and second primary occurrence as well as survival characteristics. Results Among 295 included patients, 21 (7.1%) had a locoregional recurrence; 17 (5.8%) had a distant recurrence; and 3 (1.0%) had a second primary during a median follow-up of 48.0 months (interquartile range, 29.5-62.0). Only 1 (0.3%) had a second primary found in the contralateral tonsil. The 2- and 5-year estimates of overall survival were 95.5% (SE, 1.2%) and 90.1% (SE, 2.2%), respectively, while the 2- and 5-year estimates of disease-free survival were 90.0% (SE, 1.8%) and 84.7% (SE, 2.3%). Conclusion Second primary occurrence in the contralateral tonsil was infrequent, and survival outcomes were encouraging with unilateral surgery. This provides a rationale for not routinely performing elective contralateral tonsillectomy in patients whose workup suggests unilateral disease.

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Atypical carcinoid of larynx and management using transoral robotic surgery: Supraglottic laryngectomy

Asian Journal of Oncology ◽

10.4103/2454-6798.165116 ◽

2015 ◽

Vol 01 (01) ◽

pp. 055-057

Author(s):

Anant Dinesh ◽

Himanshu Shukla ◽

Reetesh Ranjan ◽

Surender Dabas

Keyword(s):

Robotic Surgery ◽

Carcinoid Tumor ◽

Important Determinant ◽

Immunohistochemical Analysis ◽

Transoral Robotic Surgery ◽

Biological Behavior ◽

Atypical Carcinoid ◽

Supraglottic Laryngectomy ◽

Laryngeal Examination

AbstractAtypical carcinoid tumor of the larynx is a particularly rare occurrence. Here, we report a patient with a laryngeal neuroendocrine tumor (NET) who was treated with transoral robotic surgery-supraglottic laryngectomy (TORS-SL). A 73-year-old male patient, a known smoker, presented with throat pain and hoarseness for 1 month. Endoscopic laryngeal examination and magnetic resonance imaging revealed a left supraglottic mass. The results of histopathologic examination and immunohistochemical analysis were consistent with atypical carcinoid tumor of the larynx. A TORS-SL was performed. There was no recurrence during a follow-up period of 18 months. NETs of the larynx are a very heterogeneous group of tumors in terms of pathological features and biological behavior. The histological diagnosis is the most important step in the management of these tumors. Tumor histology is an important determinant of prognosis. TORS-SL is a promising, minimally invasive, endoscopic surgical alternative for the treatment of supraglottic tumors with good functional and clinical outcomes as seen in this case.

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Simultaneous submandibular gland preserving neck dissection and transoral robotic surgery for oropharygeal and supraglottic malignancies

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2015.08.258 ◽

2015 ◽

Vol 221 (4) ◽

pp. e133-e134

Author(s):

Anant Dinesh ◽

Surender Dabas ◽

Reetesh Ranjan ◽

Himanshu Shukla

Keyword(s):

Robotic Surgery ◽

Neck Dissection ◽

Submandibular Gland ◽

Transoral Robotic Surgery

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Quality of life and functional evaluation in patients with tongue base tumors treated exclusively with transoral robotic surgery: A 1-year follow-up study

Journal of Cranio-Maxillofacial Surgery ◽

10.1016/j.jcms.2015.06.024 ◽

2015 ◽

Vol 43 (8) ◽

pp. 1561-1566 ◽

Cited By ~ 14

Author(s):

Giuseppe Mercante ◽

Alessandra Masiello ◽

Isabella Sperduti ◽

Giovanni Cristalli ◽

Raul Pellini ◽

...

Keyword(s):

Quality Of Life ◽

Robotic Surgery ◽

Transoral Robotic Surgery ◽

Tongue Base ◽

Functional Evaluation ◽

Follow Up Study

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Swallowing Function Following Neoadjuvant Chemotherapy and Transoral Robotic Surgery for Oropharyngeal Carcinoma: A 2-Year Follow-up

Otolaryngology ◽

10.1177/01945998211057430 ◽

2021 ◽

pp. 019459982110574

Author(s):

Esther Lee ◽

Daniel Gorelik ◽

Hannah R. Crowder ◽

Christopher Badger ◽

Jennifer Schottler ◽

...

Keyword(s):

Robotic Surgery ◽

Neoadjuvant Chemotherapy ◽

Neck Dissection ◽

Transoral Robotic Surgery ◽

Interquartile Range ◽

Oropharyngeal Carcinoma ◽

Adjuvant Radiation ◽

Swallowing Function ◽

Patient Reported

Objective To evaluate 2-year follow-up swallowing function in patients with human papillomavirus–related oropharyngeal squamous cell carcinoma (HPV+ OPSCC) who completed neoadjuvant chemotherapy and transoral robotic surgery (NAC+S) Study Design Retrospective analysis of patients with OPSCC treated with NAC+S between 2010 and 2021. Setting A single academic institution. Methods This is a cross-sectional study of patient-reported swallowing function, assessed with the MD Anderson Dysphagia Inventory (MDADI) at least 2 years after completion of treatment. The inclusion criteria are patients with HPV+ OPSCC who underwent NAC+S at least 2 years ago. Those requiring adjuvant radiation or chemoradiation or experiencing relapse were excluded from the study. Results Completed MDADIs were received from 37 patients at a median 3.8 years posttreatment (interquartile range, 2.0-8.6 years). Of those, 94.6% (n = 35) were male and 81.1% (n = 30) were White. The median age at OPSCC diagnosis was 59.0 years (interquartile range, 41-80 years). The most frequent primary subsite of OPSCC was the base of the tongue (n = 20, 54.1%), followed by the tonsils (n = 16, 43.2%). In addition, 75.7% (n = 28) had stage IVa disease (TNM seventh edition), and 29 (78.4%) had scores ≥80, classified as optimal function. When compared with patients who received bilateral neck dissection, patients who received unilateral neck dissection were associated with an age <65 years old ( P = .036) and lower clinical TNM stage ( P = .04), as well as higher composite, emotional, functional, and physical MDADI scores ( P = .017, .046, .013, and .05, respectively). Conclusion Patients with OPSCC who were treated with NAC+S achieved satisfactory long-term swallowing outcomes. Unilateral neck dissection was significantly associated with higher MDADI scores in this patient cohort.

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Abstract A23: Transoral robotic surgery for primary oncologic resection: Outcomes from a rural academic medical center

10.1158/1557-3265.aacrahns19-a23 ◽

2020 ◽

Author(s):

Eric Eisen ◽

Christiaan Rees ◽

Isabelle Magro ◽

Karissa LeClair ◽

Joseph Paydarfar

Keyword(s):

Robotic Surgery ◽

Medical Center ◽

Academic Medical Center ◽

Transoral Robotic Surgery ◽

Oncologic Resection ◽

Academic Medical

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Minimally invasive transoral robotic surgery for hiloparenchymal submandibular stone: technical note on Flex Robotic System

10.22541/au.161527923.30654042/v1 ◽

2021 ◽

Author(s):

Pasquale Capaccio ◽

Giuseppe Riva ◽

Raffaella Cammarota ◽

Michele Gaffuri ◽

Giancarlo Pecorari

Keyword(s):

Robotic Surgery ◽

Minimally Invasive ◽

Submandibular Gland ◽

Transoral Robotic Surgery ◽

Technical Note ◽

Robotic System ◽

Minimally Invasive Technique ◽

Invasive Technique ◽

Robotic Approach ◽

System A

We described a minimally invasive technique for transoral removal of deep hiloparenchymal submandibular stones by Flex Robotic System; a step-by-step description of the transoral robotic approach to submandibular gland through a discrete incision of the oral floor is narrated. This approach guaranteed the preservation of the gland, minimizing complications.

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Lack of Adjuvant Radiotherapy May Increase Risk of Retropharyngeal Node Recurrence in Patients with Squamous Cell Carcinoma of the Head and Neck after Transoral Robotic Surgery

Case Reports in Oncological Medicine ◽

10.1155/2013/727904 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Waleed F. Mourad ◽

Dukagjin M. Blakaj ◽

Rafi Kabarriti ◽

Rebekah Young ◽

Rania A. Shourbaji ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Robotic Surgery ◽

Cell Carcinoma ◽

Head And Neck ◽

Squamous Cell ◽

Adjuvant Radiotherapy ◽

Transoral Robotic Surgery ◽

Pet Ct ◽

Pet Ct Scan

Purpose. Transoral robotic surgery (TORS) has increased in popularity in the management of squamous cell carcinoma of the head and neck. However, TORS does not address the neck or retropharyngeal nodes (RPN). In the current report, we highlight the impact of the lack of adjuvant radiotherapy on RPN recurrence after TORS.Materials and Methods. A 58-year-old Caucasian male presented with squamous cell carcinoma of the head and neck of unknown primary. He was offered radiotherapy as a definitive management for clinical stage T0N2aM0, stage IVA, but he opted to left neck dissection. Follow-up PET-CT scan revealed recurrence in the left base of tongue and right level II lymph node. He was offered radiotherapy which he declined and opted to TORS and right neck dissection. Follow-up PET-CT scan showed recurrence in left RPN for which he underwent salvage concurrent chemoradiotherapy to 70 Gy.Results. After a followup of 9 months from the date of salvage chemoradiotherapy completion, the patient is with no evidence of disease.Conclusions. TORS followed by adjuvant radiotherapy seems reasonable in the context of squamous cell carcinoma of the head and neck due to the odds of RPN involvement. Further reports are warranted to optimize post-TORS adjuvant treatment.

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