Laryngotracheal Reconstruction in Adults Aged 60 Years and Older.

OBJECTIVE: The primary aim of this study is to evaluate the safety, efficacy, and execution of major open laryngotracheal operations for patients in the advanced decades. STUDY DESIGN: Case series with chart review. SETTING: Multidisciplinary clinic at a tertiary care academic hospital. SUBJECTS AND METHODS: Patient characteristics, operative course, and postoperative outcomes were retrospectively recorded for all airway reconstruction operations performed between 1999 and 2016 on patients aged ≥60 years Long-term success was defined as prosthesis-free survival at last follow-up. Descriptive statistics were performed. RESULTS: Twenty-nine patients met inclusion criteria, and the median age was 71 years (interquartile range, 63-74). Tracheal resection was the most common procedure (13 patients), followed by laryngotracheal reconstruction (7 patients). Fifteen patients began their operation with a tracheostomy, 6 of whom underwent decannulation prior to leaving the operating room. Three additional patients underwent decannulation at follow-up appointments and were prosthesis-free at most recent follow-up. The mean time to decannulation among these patients was 3 months. Of the 14 patients beginning their procedure without a tracheostomy, only 2 required permanent airway prosthesis. The overall long-term rate of prosthesis-free survival was 72.4% (21 of 29 patients). Factors suggestive of long-term success include lower McCaffrey grade and lack of pulmonary disease, hypertension, or diabetes, as well as decreased red blood cell distribution width on preoperative complete blood count. CONCLUSION: Through careful patient selection, preoperative workup, and meticulous postoperative care, airway reconstruction procedures in patients aged ≥60 years are reasonably successful. Of 29 patients, 21 (72.4%) were successfully breathing long-term without airway prosthesis.

Transoral robotic surgery frontiers.

Transoral robotic surgery is a exciting field that continues to develop and push the boundaries of current procedural ability and challenges historical treatment paradigms. With the first use of a surgical robot in 1985, to the first clinical use of the robot transorally in 2005, there was some lag in adoption of robotic techniques in the head and neck region. However, since 2005 transoral robotic surgery has rapidly gained momentum amongst head and neck surgeons. With FDA approval of the da Vinci robot in 2009, transoral robotic surgery is currently offered as a treatment modality for malignant and nonmalignant disease of the head and neck region. This new technology is being used to reconsider historical treatment paradigms for malignancies of the upper aerodigestive tract due to the fact that minimally invasive surgical access to the oropharynx and larynx has been improved. Along with this enhanced access have come innovative procedures and uses of the technology for multiple facets of head and neck disease. Technology continues to improve and innovation in surgical robotics is expected to continue as more companies attempt to capture this market. This article aims to provide a view at the landscape of transoral robotic surgery and explore the future frontiers.

Forces Applied at the Skull Base during Transnasal Endoscopic Transsphenoidal Pituitary Tumor Excision.

Objectives Our laboratory is developing a surgical robotic system to further improve dexterity and visualization that will allow for broader application of transnasal skull base surgery. To optimize this system, intraoperative force data are required. Using a modified curette, force data were recorded and analyzed during pituitary tumor excision. Design A neurosurgical curette was modified by the addition of a force sensor. The instrument was validated in an in vitro model to measure forces during simulated pituitary tumor excision. Following this, intraoperative force data from three patients during transnasal endoscopic excision of pituitary tumors was obtained. Setting Academic medical center. Main Outcome Measures Forces applied at the skull base during surgical excision of pituitary tumors. Results Average forces applied during in vitro testing ranged from 0.1 to 0.15 N. Average forces recorded during in vivo testing ranged from 0.1 to 0.5 N. Maximal forces occurred with collisions of the bony sella. The average maximal force was 1.61 N. There were no complications related to the use of the modified curette. Conclusions Forces to remove pituitary tumor are small and are similar between patients. The in vitro model presented here is adequate for further testing of a robotic skull base surgery system.