Semin Plast Surg 2014; 28(01): 035-038
DOI: 10.1055/s-0034-1368166
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Transoral Robotic Reconstructive Surgery

Jesse C. Selber
1   Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center, Houston, Texas
,
Karim A. Sarhane
2   Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
,
Amir E. Ibrahim
1   Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center, Houston, Texas
,
Floyd C. Holsinger
3   Department of Otolaryngology–Head & Neck Surgery, Stanford University School of Medicine, Stanford, California
› Author Affiliations
Further Information

Publication History

Publication Date:
07 March 2014 (online)

Abstract

Transoral robotic surgery (TORS) has emerged as a technique that allows head and neck surgeons to safely resect large and complex oropharyngeal tumors without dividing the mandible or performing a lip-split incision. These resections provide a reconstructive challenge because the cylinder of the oropharynx remains closed and both physical access and visualization of oropharyngeal anatomy is severely restricted. Transoral robotic reconstruction (TORRS) of such defects allows the reconstructive surgeon to inset free flaps or perform adjacent tissue transfer while seeing what the resecting surgeon sees. Early experience with this technique has proved feasible and effective. Robotic reconstruction has many distinct advantages over conventional surgery, and offers patients a less morbid surgical course. In this review, we discuss the clinical applicability of transoral robotic surgery in head and neck reconstruction, highlighting the benefits and limitations of such an approach, and outlining the guidelines for its utilization.

 
  • References

  • 1 Selber J. Discussion: robotic-assisted FAMM flap for soft palate reconstruction. Laryngoscope 2014; Jan 28; [Epub ahead of print]
  • 2 The Department of Veterans Affairs Laryngeal Cancer Study Group. Induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced laryngeal cancer. N Engl J Med 1991; 324 (24) 1685-1690
  • 3 Ozer E, Waltonen J. Transoral robotic nasopharyngectomy: a novel approach for nasopharyngeal lesions. Laryngoscope 2008; 118 (9) 1613-1616
  • 4 Campbell BH, Spinelli K, Marbella AM, Myers KB, Kuhn JC, Layde PM. Aspiration, weight loss, and quality of life in head and neck cancer survivors. Arch Otolaryngol Head Neck Surg 2004; 130 (9) 1100-1103
  • 5 Kotz T, Costello R, Li Y, Posner MR. Swallowing dysfunction after chemoradiation for advanced squamous cell carcinoma of the head and neck. Head Neck 2004; 26 (4) 365-372
  • 6 Rademaker AW, Vonesh EF, Logemann JA , et al. Eating ability in head and neck cancer patients after treatment with chemoradiation: a 12-month follow-up study accounting for dropout. Head Neck 2003; 25 (12) 1034-1041
  • 7 Roh J-L, Kim A-Y, Cho MJ. Xerostomia following radiotherapy of the head and neck affects vocal function. J Clin Oncol 2005; 23 (13) 3016-3023
  • 8 Machtay M, Rosenthal DI, Hershock D , et al; Penn Cancer Center Clinical Trials Group. Organ preservation therapy using induction plus concurrent chemoradiation for advanced resectable oropharyngeal carcinoma: a University of Pennsylvania Phase II Trial. J Clin Oncol 2002; 20 (19) 3964-3971
  • 9 Ibrahim AE, Sarhane KA, Baroud JS, Atiyeh BS. Robotics in plastic surgery, a review. Eur J Plast Surg 2012; 35 (8) 571-578
  • 10 Iseli TA, Kulbersh BD, Iseli CE, Carroll WR, Rosenthal EL, Magnuson JS. Functional outcomes after transoral robotic surgery for head and neck cancer. Otolaryngol Head Neck Surg 2009; 141 (2) 166-171
  • 11 Moore EJ, Olsen KD, Kasperbauer JL. Transoral robotic surgery for oropharyngeal squamous cell carcinoma: a prospective study of feasibility and functional outcomes. Laryngoscope 2009; 119 (11) 2156-2164
  • 12 Song HG, Yun IS, Lee WJ, Lew DH, Rah DK. Robot-assisted free flap in head and neck reconstruction. Arch Plast Surg 2013; 40 (4) 353-358
  • 13 de Almeida JR, Park RCW, Genden EM. Reconstruction of transoral robotic surgery defects: principles and techniques. J Reconstr Microsurg 2012; 28 (7) 465-472
  • 14 Selber JC, Robb G, Serletti JM, Weinstein G, Weber R, Holsinger FC. Transoral robotic free flap reconstruction of oropharyngeal defects: a preclinical investigation. Plast Reconstr Surg 2010; 125 (3) 896-900
  • 15 Selber JC. Transoral robotic reconstruction of oropharyngeal defects: a case series. Plast Reconstr Surg 2010; 126 (6) 1978-1987
  • 16 Longfield EA, Holsinger FC, Selber JC. Reconstruction after robotic head and neck surgery: when and why. J Reconstr Microsurg 2012; 28 (7) 445-450
  • 17 Holsinger FC, McWhorter AJ, Ménard M, Garcia D, Laccourreye O. Transoral lateral oropharyngectomy for squamous cell carcinoma of the tonsillar region: I. Technique, complications, and functional results. Arch Otolaryngol Head Neck Surg 2005; 131 (7) 583-591
  • 18 Laccourreye O, Hans S, Ménard M, Garcia D, Brasnu D, Holsinger FC. Transoral lateral oropharyngectomy for squamous cell carcinoma of the tonsillar region: II. An analysis of the incidence, related variables, and consequences of local recurrence. Arch Otolaryngol Head Neck Surg 2005; 131 (7) 592-599
  • 19 Rieger J, Bohle Iii G, Huryn J, Tang JL, Harris J, Seikaly H. Surgical reconstruction versus prosthetic obturation of extensive soft palate defects: a comparison of speech outcomes. Int J Prosthodont 2009; 22 (6) 566-572
  • 20 Marsh JL, Wray RC. Speech prosthesis versus pharyngeal flap: a randomized evaluation of the management of velopharyngeal incompetency. Plast Reconstr Surg 1980; 65 (5) 592-594
  • 21 Atiyeh BS, Sarhane KA. Overweight and obesity: a true global epidemic. In: Atiyeh BS, Costagliola M, , eds. Body Contouring Following Bariatric Surgery and Massive Weight Loss Post-Bariatric Body Contouring. Sharjah, United Arab Emirates: Bentham Science Publishers; 2012: 3-11
  • 22 Sarhane KA, Flores JM, Cooney CM , et al. Preoperative anemia and postoperative outcomes in immediate breast reconstructive surgery: a critical analysis of 10,958 patients from the ACS-NSQIP database. Plast Reconstr Surg 2013; ; in press
  • 23 Hill JB, Patel A, Del Corral GA , et al. Preoperative anemia predicts thrombosis and free flap failure in microvascular reconstruction. Ann Plast Surg 2012; 69 (4) 364-367