Transorale Roboter-assistierte Chirurgie von Kopf-Hals-Tumoren: Eine Fallserie mit 17 Patienten

Zusammenfassung

Hintergrund:

In der Kopf-Hals-Tumorchirurgie gewann in den letzten Jahren, insbesondere in Nordamerika, die transorale Roboter-assistierte Chirurgie (TORS) an Bedeutung. Demgegenüber beschäftigen sich in Deutschland bisher nur wenige Arbeitsgruppen mit der Anwendung dieses Systems. Aufgrund der zu erwartenden Weiterentwicklung von Robotersystemen halten wir es für sinnvoll sich dieser neuen Technik zu stellen.

Material und Methoden:

Im Zeitraum von Mai 2011 bis Juni 2012 wurden an unserer Klinik 17 Patienten mit Tumoren des Oropharynx, des Zungengrunds und der Supraglottis mit dem da Vinci SI HD® System operiert. In einer prospektiven Untersuchung überprüften wir das Verfahren in Hinblick auf Einstellbarkeit, Visualisierung, und Resektabilität des Tumors. Zusätzlich wurden die Vorbereitungs- und Operationszeiten erfasst und die Kosten des Systems evaluiert.

Ergebnisse:

Alle Tumore des Zungengrunds (n=5) und des Oropharynx (n=9) konnten gut eingestellt, visualisiert und reseziert werden. Im Bereich der Supraglottis (n=3) waren 2 Tumore nicht ausreichend einstellbar und die Operation wurde mit einer transoralen mikroskopischen Laserresektion zu Ende geführt. Das elektrische Messer und der Tm:Yag-Laser des da Vinci-Roboters schnitten mit einer breiten Koagulationszone bei guter Blutstillung. Die Kosten für den medizinischen Bedarf und die Leasinggebühren betrugen in unserer Klinik 6 280 € pro Fall.

Schlussfolgerung:

Im Bereich des Zungengrunds und des Oropharynx gelang eine gute Visualisierung des Tumors mit dem da Vinci-System. Im supraglottischen Bereich kann aufgrund der Anordnung der Roboterarme und der engen anatomischen Verhältnisse die Resektion der Tumore erschwert sein. Trotz der hohen Kosten stellt das da Vinci-System eine interessante Ergänzung der bestehenden chirurgischen Verfahren dar.

Abstract

Transoral Robotic Surgery for Head and Neck Tumors: A Series of 17 Patients

Background:

Within the last years transoral robotic surgery (TORS) has gained importance in the resection of head and neck tumors, especially in North America. In contrast only few groups in Germany have studied this system so far. In respect to potential future developments in surgical robotic systems it seems reasonable to deal with this system.

Material and Methods:

17 patients with tumors of the oropharynx, the base of tongue or the supraglottic area were treated with TORS in our clinic, between May 2011 and June 2012. In a prospective study we analyzed the exposure, visualization and resectability of these tumors using the da Vinci-system. In addition, set up and operation time, as well as costs were evaluated.

Results:

All neoplasms of the oropharynx (n=9) and the tongue base (n=5) could be well exposed, visualized and resected. In the supraglottic area (n=3) 2 tumors could not be properly exposed and therefore resection was converted to a transoral microscopic laser approach. Resection with the cautery spatula tip or the Tm:YAG-laser fibre caused wide coagulation zones, but resulted in good hemostasis. The costs for the medical equipment and the leasing rate were 6 280 € per case at our institution.

Conclusion:

Tumors of the tongue base and oropharynx could be easily visualized with help of the da Vinci-system. The resection of supraglottic tumors can be challenging, due to the arrangement of the robotic-arms and the narrow anatomic conditions. Despite its high costs, the da Vinci-system is a potentially interesting supplementation to existing surgical techniques.

Schlüsselwörter

TORS - Plattenepithelkarzinom - Pharynxtumore - supraglottische Tumore - transorale Resektion - Laserchirurgie - 3D Endoskopie

Key words

TORS - squamous cell carcinoma - pharyngeal neoplasms - supraglottic neoplasms - transoral resection - laser surgery

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