First Series of Free Flap Reconstruction Using a Dedicated Robotic System in a Multidisciplinary Microsurgical Center.

Robotic microsurgery is a novel technology for microsurgical free flap transplantation in reconstructive surgery. Recently, the first free flap transplantation using a dedicated robotic system for microsurgery (Symani Surgical System; Medical Microinstruments) was published for a single reconstructive case. For broader future application, evaluating its potential benefits in different anatomical regions, anastomotic configurations, and clinical scenarios is necessary. In this world-wide first free flap series using this robotic system, we describe our experience with this new technology in a multidisciplinary microsurgical center. The robotic system was used for different free flaps in a range of reconstructive applications in plastic surgery, oral and maxillofacial surgery, and head and neck surgery. A total of 23 flaps were performed, with all 23 arterial and a selection of two venous anastomoses being performed with the robotic system. Time for anastomoses was significantly longer than commonly. Five of the arterial robotic anastomoses had to be redone. All but one flap survived. We could show that this new dedicated microsurgical robotic system is feasible for carrying out robot-assisted anastomoses in end-to-end, as well as end-to-side fashion under varying clinical conditions and in different microsurgical subspecialties. However, some drawbacks still need to be overcome, which are partly related to individual and institutional learning curves, to finally estimate the potential benefit for robotic free flap surgery. Multidisciplinary application of the robotic system may accelerate this process by putting together different microsurgical backgrounds, while economic burden of establishing this new technology is spread among several departments.

[Data from the 2022 ASCO Annual Meeting on surgical therapy]. / Daten vom ASCO-Kongress 2022 zum Thema "chirurgische Therapie".

Last year, studies on immuno-oncologic treatment approaches for recurrent or metastatic head and neck cancer were the main focus at the two major international cancer congresses of the American Society of Clinical Oncology (ASCO) and the European Society for Medical Oncology (ESMO). The success of these therapeutic strategies has led to many new studies, including their use in the neoadjuvant setting. This review article summarizes presented studies from ASCO 2022 in which surgical therapy is the focus of the study protocol and also includes study results on neoadjuvant treatment strategies. No surgical trials were presented at ESMO 2022. At ASCO 2022 as well as in previous years, it became increasingly clear that treatment de-escalation in the context of human papillomavirus (HPV)-associated oropharyngeal carcinoma treatment involving surgical measures appears to be oncologically safe and functionally beneficial. In addition, a number of studies indicate that in the setting of neoadjuvant administration of immuno-oncologic agents, a proportion of patients have pathologic complete remission. In this fraction of patients, which is usually significantly smaller than 50%, survival data are better than in those who have already failed to respond to neoadjuvant therapy. Unfortunately, however, significant toxicities or tumor progression with the risk of inoperability were also seen under these current therapeutic regimens, leading to discontinuation of therapy in 5-20% of cases. It remains to be seen whether neoadjuvancy with immune checkpoint inhibitors can establish itself, in contrast to the failed attempts of the past with the use of cytostatics.

[Neuroendocrine tumors in head and neck]. / Neuroendokrine Tumoren im Kopf-, Halsbereich.

INTRODUCTION: NETs are benign or malign tumors, which originate from cells of the endocrine (hormonal) and nervous systems. 0,5-2 % of the neoplasms are neuroendocrine tumors, which are mostly located in the gastrointestinal or bronchopulmonal tract. Die incidence is about 9000/100000. 1% of the head and neck tumors are NET. This study evaluates NETs with different locations, its therapy and outcome. METHODS: 14 patients with a neuroendocrine tumor of the head and neck between 2010 and 2017 were evaluated. 8 patients underwent an operation and adjuvant radiochemotherapy (RCT). Five patients had a prim. RCT with curative intention. One patient had a palliative chemotherapy because of the progress after the radiochemotherapy. RESULTS: The locations of the tumors are the larynx (n=7), parotid gland (n=2) and the paranasal sinuses (n=5). A resection in sano (R0) could be reached in 6 of 8 cases. The average survival rate was 19±6 months. 2 tumor recurrences occurred out of 14 patients. 1 patient died after 7 months und 1 patient is without recurrence after 32 months. 2 patients had no benefit of the combined radiochemotherapy and died after 6 and 13 months. Die overall survival depends on the stage and the R0 resection of the tumors. The R0 resection is better in comparison to the prim. according to the overall survival time. CONCLUSION: Patients with NET of the head and neck have to be treated in specialized cancer centers. Each patient should receive an individual therapy depending on localization and histopathological findings.

Evaluation of gender-specific aspects in quality-of-life in patients with larynx carcinoma.

CONCLUSIONS: The results suggest that gender-specific differences in health-related quality-of-life (HRQoL) exist in patients with larynx carcinoma. In previous studies these differences might have been concealed by predominantly male subject groups. Future studies should consider a gender-specific analysis that suits the patient's idiosyncrasies associated with laryngeal cancer. OBJECTIVES: There is little research concerning gender differences in quality-of-life (QoL) in patients with larynx carcinoma. Since laryngeal cancer is predominantly found in males, most studies examining HRQoL are based on a mainly male subject group. HRQoL needs to be assessed to determine the impact of disease and treatment and to evaluate possible treatment regimes. This study examined gender differences concerning HRQoL in 53 patients using EORTC QLQ-C30, and QLQ-H&N35 questionnaires. METHODS: Patients treated with larynx carcinoma were given two questionnaires to assess HRQoL. The questionnaires were analyzed for each sex separately, as well as for the entire population. RESULTS: Female patients report significantly worse HRQoL than males. Age could not be identified as a significant predictor for HRQoL when males and females were analyzed together, and does not significantly predict HRQoL in men. However, age was found to be a significant predictor for HRQoL when only females were analyzed.

Vestibular rehabilitation using the Nintendo® Wii Balance Board -- a user-friendly alternative for central nervous compensation.

CONCLUSION: The Nintendo® Wii Balance Board is a cost-effective and user-friendly alternative to other popular frequently used systems that aid vestibular compensation, particularly in elderly patients. In addition, further treatment in the home environment is possible. OBJECTIVE: This cohort study was designed to investigate the impact of the Nintendo® Wii Balance Board as a visual compensation device after acute vestibular neuritis. METHODS: Subjects were randomly assigned to one of two treatment groups. Group A (n = 37) performed customized exercises with the Nintendo® Wii Balance Board. Group B (n = 34) performed only two elected exercises as a control group for comparison of the results. Both groups underwent additive therapy with steroids (intravenous) in decreasing doses (250 mg decreasing to 25 mg over 10 days). The Sensory Organization Test (SOT), Dizziness Handicap Inventory (DHI), Vertigo Symptom Scale (VSS), and Tinneti questionnaire were evaluated immediately before treatment (baseline), at the end of treatment, i.e. at day 5, and after 10 weeks. RESULTS: The early use of a visual feedback system in the context of the balance training supports the central nervous vestibular compensation after peripheral labyrinthine disorders. Patients in group B (without training) required a longer in-patient stay (average 2.4 days, SD 0.4) compared with patients following early Wii rehabilitation. The absence of nystagmus under Frenzel's goggles in group A was observed 2.1 days (SD 0.5) earlier than in group B. Group A showed significantly better results in the SOT, DHI, VSS, and Tinneti questionnaire at all time points measured (p < 0.05).

Pharmacological modulation of transmitter release by inhibition of pressure-dependent potassium currents in vestibular hair cells.

Vestibular vertigo may be induced by increases in the endolymphatic pressure that activate pressure-dependent K(+) currents (I(K,p)) in vestibular hair cells. I(K,p) have been demonstrated to modulate transmitter release and are inhibited by low concentrations of cinnarizine. Beneficial effects against vestibular vertigo of cinnarizine have been attributed to its inhibition of calcium currents. Our aim was to determine the extent by which the inhibition of I(K,p) by cinnarizine may alter the voltage response to stimulating currents and to analyze whether such alterations may be sufficient to modulate the activation of Ca(2+) currents and transmitter release. Vestibular type II hair cells from guinea pigs were studied using the whole-cell patch-clamp technique. In current clamp, voltage responses to trains of stimulating currents were recorded. In voltage clamp, transmitter release was assessed from changes in the cell capacitance, as calculated from the phase shift during application of sine waves. Cinnarizine (0.05-3 microM) concentration dependently reversed the depressing effects of increases in the hydrostatic pressure (from 0.2 to 0.5 cm H(2)O) on the voltage responses to stimulating currents. Voltage protocols that simulated these responses were applied in voltage clamp and revealed a significantly enhanced transmitter release in conditions mimicking an inhibition of I(K,p). Cinnarizine (< or =0.5 microM) did not inhibit calcium currents. We conclude that cinnarizine, in pharmacologically relevant concentrations, enhances transmitter release in the presence of elevated hydrostatic pressure by an indirect mechanism, involving inhibition of I(K,p), enhancing depolarization, and increasing the voltage-dependent activation of Ca(2+) currents, without directly affecting Ca(2+) current.

Potassium currents induced by hydrostatic pressure modulate membrane potential and transmitter release in vestibular type II hair cells.

Vestibular type II hair cells respond to increases in the hydrostatic pressure with pressure-dependent K(+) currents. We examined whether such currents may modulate transmitter release (assessed as membrane capacitance increments) by altering membrane potentials and voltage-gated Ca(2+) currents. Capacitance increments were dependent on voltage-gated Ca(2+) influx. Stimulating currents (0.7 nA) in current clamp induced depolarisations that were more negative by 8.7 +/- 2.1 mV when the bath height was elevated from 0.2 to 0.5 cm. In voltage clamp, protocols were used that simulated the time course of the membrane potential in current clamp at either low (control) or high hydrostatic pressure (high bath). The low bath protocol induced significantly larger Ca(2+) currents and increases in capacitance than the high bath protocol. We conclude that pressure-dependent K(+) currents may alter the voltage response of vestibular hair cells to an extent critical for Ca(2+) currents and transmitter release. This mechanism may contribute to vestibular dysfunction in Meniere's disease.

Ultrasonic bath depth control and regulation in single cell recordings.

Control of the bath depth is critical in many applications of the patch-clamp technique, particularly when the capacitance of cells is determined to assess secretion or transmitter release or in studies of ion currents sensitive to small changes in the hydrostatic pressure. We describe an inexpensive technique for tight control of the bath depth with the aid of a commercially available ultrasound sensor. The sensor continuously determines changes in the distance to the bath surface with a resolution of about 10 mum. The signal from the sensor is digitized in a microcontroller card and used to send on or off signals at 100 Hz to a peristaltic pump that removes volume from the bath. The inflow into the bath can be realized in a versatile way. The capacitance of Sylgard-coated patch-clamp glass electrodes, demonstrated to be extremely sensitive to small changes in the area moistened by bath solution, is constant within the noise level of +/-3 fF when immersed into a depth-controlled bath, even during exchange of the bath medium. Thus, when small changes in the cell capacitance are measured in patch-clamp experiments, errors due to alterations in the pipette capacitance caused by bath depth fluctuations are eliminated.