Transoral robotic surgery for parapharyngeal lesions: a case series of four benign tumours.

OBJECTIVES: The parapharyngeal space (PPS) is an anatomically complex space in the vicinity of vital structures. With the introduction of the daVinci robot in head and neck surgery, the surgical robotic system is now being used to gain direct access to the parapharyngeal space and to excise the tumors endoscopically. This study evaluates the outcomes of four patients with benign PPS tumors treated with a transoral robotic surgery approach in a single centre. MATERIAL AND METHODS: All patients with benign tumors of the PPS who underwent transoral resection (between January 2012 and June 2014) using the robot were included in this retrospective study. RESULTS: The study population comprised of two males and two females with a mean age of 52 (range 34-66 years). The parapharyngeal mass was successfully transorally removed in all cases. Overall, mean length of stay was 3.25 days with mean time to oral diet of one day. No intraoperative, perioperative or postoperative complications were encountered. The histological diagnosis was pleomorphic adenoma in two cases (50%). The other two cases were: schwannoma and angioma. There were no recurrences on radiological investigations during a mean follow-up of 14.5 months. MRI scan showed a stable residual fibrotic lesion in case of the angioma. The preoperative complaints of mucus in the throat, painless swelling of the soft palate or throat burden of all patients resolved after surgery. CONCLUSION: With the assistance of the surgical robotic system, benign tumors within the PPS can be excised safely without neck incisions. Further long-term evaluation is needed to define patient selection and the role of TORS for PPS neoplasms.

Transaxillary robotic thyroidectomy: Belgian team learning from the first 50 cases.

BACKGROUND: In search for less invasive operative techniques, the da Vinci Robot System was introduced in thyroid surgery. Previous studies have reported on safety, effectiveness and improved cosmetics of transaxillary endoscopic thyroidectomy procedures in selected cases. METHODS: We report on the first 50 patients that have been treated with a gasless transaxillary robot-assisted thyroidectomy in a Belgian institution. We describe the implementation, the operative technique and results of robotic thyroid surgery. RESULTS: 48 hemithyroidectomy and 2 total thyroidectomy procedures were performed. The mean ultrasound dimensions of the nodules were 3.4 ± 1.0 cm (range 1.0-8.0 cm). The mean operative time was significantly longer than with a conventional open approach: 215 min ± 55 min (range 133 min-347 min). No major complications were observed. All patients were "satisfied" about the cosmetic outcome. CONCLUSION: Transaxillary robotic thyroid surgery is demanding, but feasible. Selected patients can benefit from this technique with an optimal cosmetic outcome. Ideal indication in the hand of our team is a hemithyroidectomy for benign nodules ranging up to 5 cm.

Congenital laryngeal cyst: an unusual cause of stridor in the neonate.

BACKGROUND: Congenital laryngeal cysts are a rare, but potentially fatal, cause of airway obstruction in infants and children. Most laryngeal cysts are acquired. Here, we describe a congenital laryngeal cyst, its treatment, and its presentation immediately after birth. CASE REPORT: A newborn child developed stridor very shortly after birth, due to a large, congenital saccular cyst. The diagnosis was based on a laryngoscopy and imaging studies, which detected an extralaryngeal extension through the cricothyroid membrane. The cyst was removed with an endoscopic procedure and a CO2-laser. Afterwards, the cyst recurred, but was successfully removed with an external approach. CONCLUSION: Clinical manifestations of laryngeal cysts in neonates shortly after birth are rare. Here, we present an interesting clinical case. We also concisely reviewed the literature on the epidemiology, clinical presentation, diagnosis, classification, and therapy for laryngeal cysts.

Advances in the medical management of differentiated thyroid carcinoma and their impact on the surgical approach.

The introduction of recombinant human TSH and neck ultrasonography has refined the management of differentiated thyroid cancer, leading to the publication of new guidelines by the American Thyroid Association (ATA) and a consensus report by the European Thyroid Association (ETA) in 2006. In this paper, we give an overview of the current medical management of differentiated thyroid cancer (pre-surgical, post-surgical), of how the advances have been integrated into the recent 2006 ATA guidelines and ETA consensus and finally, of the impact on the surgical management (first surgery, treatment of cervical lymph nodes) of differentiated thyroid cancer.

Comparing the microdebrider and standard instruments in endoscopic sinus surgery: a double-blind randomised study.

UNLABELLED: Comparing the microdebrider and standard instruments in endoscopic sinus surgery: a double-blind randomised study. OBJECTIVE: It is frequently stated that microdebriders provide better mucosal preservation in endoscopic sinus surgery (ESS), and therefore better and faster healing, when compared to the standard Blakesley instruments. However, evidence from comparative prospective studies is lacking. In this study, we compared the results of microdebriders with traditional surgical instruments for ESS. METHODS: A prospective, randomised, comparative, double-blind study in 50 patients undergoing bilateral ESS. Each patient was operated on with both instruments: one side of the nose with the microdebrider only, and the other side with standard instruments. The outcome of surgery was measured by using a symptom score and an endoscopic score at five time points during the first six postoperative months. RESULTS: Both instruments resulted in symptom improvement and in endoscopically visible healing over time, but no significant difference was found between the two techniques. In endoscopic evaluation, only the total score at 3 weeks after surgery was significantly better in the microdebrider group. No significant difference was found at any other time point. Synechia formation, patency of middle meatal antrostomy, and open access to the ethmoid were the same in both groups. CONCLUSION: In this study of endoscopic sinus surgery the use of the microdebrider does not offer major advantages compared to the standard instruments.

Pneumosinus dilatans and orbital meningioma in neurofibromatosis type 2.

We report on a 9-year-old boy with neurofibromatosis type 2 and a progressive proptosis of the left eye. Imaging studies revealed a pneumosinus dilatans of the left ethmoidal and frontal sinuses and an adjacent left orbital mass. Incision biopsy of the orbital mass showed a meningiothelial meningioma. Orbital and intracranial meningiomas are frequently associated with pneumosinus dilatans. This report illustrates the relationship of pneumosinus dilatans, intra-orbital meningioma and neurofibromatosis type 2.

Cutting forceps in functional endoscopic sinus surgery.

Twenty years of Functional Endoscopic Sinus Surgery have brought about a large amount of innovations and a variety of instruments, all claiming to result in better endoscopic procedures and/or better postoperative outcome. An example of such an innovation is the cutting forceps, which has been claimed to result in better wound healing. However, like several other instruments, it has never been proven to be superior to conventional non-cutting forceps techniques. A prospective, randomised double-blind study in 100 consecutive patients, undergoing bilateral FESS, compared the short term clinical outcome of surgery using cutting instruments to that of non-cutting instruments. Symptoms and endoscopic findings were evaluated at four time points during the first three postoperative weeks. Both types of surgery resulted in reduction of symptoms and in endoscopically visible healing over time, but no significant difference between the two methods was found, neither in symptom relief, nor in endoscopic impression of improvement. In conclusion, endoscopic sinus surgery with cutting instruments can be considered effective in resolving sinus disease. However, these instruments do not generate a better healing process than non-cutting instruments in the first weeks postoperatively.