Transcervical ultrasonography is feasible to visualize and evaluate base of tongue cancers.

BACKGROUND: Base of tongue (BOT) is a difficult subsite to examine clinically and radiographically. Yet, anatomic delineation of the primary tumor site, its extension to adjacent sites or across midline, and endophytic vs. exophytic extent are important characteristics for staging and treatment planning. We hypothesized that ultrasound could be used to visualize and describe BOT tumors. METHODS: Transcervical ultrasound was performed using a standardized protocol in cases and controls. Cases had suspected or confirmed BOT malignancy. Controls were healthy individuals without known malignancy. RESULTS: 100% of BOT tumors were visualized. On ultrasound BOT tumors were hypoechoic (90.9%) with irregular margins (95.5%). Ultrasound could be used to characterize adjacent site involvement, midline extent, and endophytic extent, and visualize the lingual artery. No tumors were suspected for controls. CONCLUSIONS: Ultrasonography can be used to transcervically visualize BOT tumors and provides clinically relevant characteristics that may not otherwise be appreciable.

Robotic-assisted skull base surgery: preclinical study.

OBJECTIVE AND STUDY DESIGN: To assess the feasibility of robotic-assisted skull base surgery, a preclincal cadaver study was conducted. MATERIALS AND METHODS: The feasibility study was subdivided into three phases: Phase 1 (surgical corridor) entailed a review of the surgical access, Phase 2 (instrument configuration) entailed arrangements of the robotic instrument (da Vinci(®) Surgical System; Intuitive Surgical, Sunnyvale, CA) in relation to the surgical corridor and applied to a skull model, and Phase 3 was robotic-assisted skull base cadaver dissection. RESULTS: Regarding the surgical corridor, the infratemporal area was accessed through a maxillary window, whereas the anterior skull base region was accessed through a combined single maxillary window and nasal corridor. Regarding instrument configuration, the camera was positioned above the two instrument arms, with both instrument arms angled at 30° to the camera axis with a flexed distal tip for the infratemporal skull base. For the anterior skull base, one of the robotic arms was inserted through the unilateral maxillary window, whereas the three-dimensional camera and the second arm were inserted through the nasal corridor. Regarding the robotic-assisted skull base cadaver dissection, we define the robotic set-up time in this study as the time required to move the robot into position, obtain adequate operative exposure, and place the robotic arms prior to the start of robotic dissection. The robotic set-up time for the anterior skull base dissection averaged 95 minutes, and that for pituitary resection was 61 minutes. The robotic set-up time for infratemporal dissection averaged 23 minutes. Operative time was 63.5 minutes. Robotic and endoscopic techniques can be combined during surgery. CONCLUSIONS: Robotic-assisted skull base surgery is feasible. The da Vinci instrument needs to be redesigned to be smaller and preferably with distal articulating tips, prior to clinical application of robotics to skull base surgery.

Robotic-assisted neck dissection through a pre- and post-auricular hairline incision: preclinical study.

The introduction of robotics in head and neck surgery has facilitated access to the contents of the neck region using less cosmetically obtrusive incisions. Robotic systems offer a three-dimensional viewing, tremor filtration, and articulating distal arms that mimic natural hand and wrist movements. We hypothesized that these characteristics would allow for the performance of a robotic-assisted selective and comprehensive neck dissection via combined pre- and post-auricular incisions. We were able to demonstrate adequate access in a cadaver, using a combination of conventional, endoscopic, and robotic surgical manipulation. Thus preclinical cadaver studies support the ability to perform robotic-assisted neck dissection via combined pre- and post-auricular incisions.

Transoral robotic surgery of the vocal cord.

The standard endoscopic surgical approach in the management of laryngeal lesions is by the use of a laryngoscope, microscope, and laser. This requires the surgeon to work within the confines of the laryngoscope. At times, it requires repositioning of the laryngoscope and microscope to gain access to a specific area. The surgery also requires line-of-sight observation to complete the operation. The introduction of transoral robotic surgery in head and neck surgery brings the advantages of three-dimensional magnification, increased degrees of freedom with the effector arms, and an articulating distal end that mimics hand movements. To date, transoral robotic surgery of vocal cord surgery requires the use of a tracheostomy in patients. Here we report the use of a CO(2) laser fiber and the Da Vinci robotic platform (Intuitive Surgical) for the surgical management of a T1 glottic squamous cell carcinoma.