Transoral robotic surgery (TORS) for base of tongue neoplasms
Transoral robotic surgery (TORS) for base of tongue neoplasms
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DOI：
10.1097/01.mlg.0000227184.90514.1a
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发表时间：
2006-08-01
期刊：
影响因子：
2.6
通讯作者：
Hockstein, Neil G.
中科院分区：
文献类型：
--
作者：
O'Malley, Bert W., Jr.;Weinstein, Gregory S.;Hockstein, Neil G.
Objective.利用机器人手术器械的光学和技术优势，开发一种治疗舌根肿瘤的微创手术技术。研究设计：对三具尸体和两只杂种狗进行了十项实验程序，包括舌根暴露和解剖。然后在前瞻性人体试验中对三名舌根癌患者进行经口机器人手术（TORS）。方法：使用da芬奇手术机器人（Intuitive Surgical，Inc.，桑尼维尔，加利福尼亚州），我们进行了总共10个无牙和齿状尸体以及生活杂种狗舌根切除术。在尸体模型中，使用三种不同的牵开器（Dingman、Crowe Davis和FK牵开器）评价暴露。这三名人类患者在机构审查委员会批准的前瞻性临床试验下接受了舌根癌的TOPS手术。开发了识别和保留或切除关键解剖结构（如舌咽神经、舌下神经和舌神经）的能力以及识别舌动脉和实现止血的技术。结果如下：达芬奇手术机器人提供了良好的可视化，并能够在尸体，狗和人类患者中切除口腔舌头的后三分之一至一半。在评价的三种牵开器中，FK牵开器提供了最大的多功能性和机器人器械可操作性的整体暴露。在活体患者手术中实现了完全切除至阴性手术切缘，止血效果良好，无并发症。结论：TORS提供了良好的三维可视化和器械入路，允许从尸体模型到人类患者的成功手术切除。TORS是治疗舌肿瘤的一种新型微创方法，与传统开放手术或内镜下经口激光手术相比具有显著优势。
Objective. To develop a minimally invasive surgical technique for the treatment of base of tongue neoplasms using the optical and technical advantages of robotic surgical instrumentation. Study Design: Ten experimental procedures including tongue base exposure and dissections were performed on three cadavers and two mongrel dogs. Transoral robotic surgery (TORS) was then performed on three human patients with tongue base cancers in a prospective human trial. Methods: Using the da Vinci Surgical Robot (Intuitive Surgical, Inc., Sunnyvale, CA), we performed a total of 10 base of tongue resections on edentulous and dentate cadavers as well as live mongrel dogs. In the cadaver models, exposure was evaluated using three different retractors, the Dingman, Crowe Davis, and FK retractors. The three human patients underwent TOPS surgery of their tongue base cancers under an institutional review board approved prospective clinical trial. The ability to identify and preserve or resect key anatomic structures such as the glossopharyngeal, hypoglossal, and lingual nerves as well as techniques for identifying the lingual artery and achieving hemostasis were developed. Results: The da Vinci Surgical Robot provided excellent visualization and enabled removal of the posterior one third to one half of the oral tongue in cadavers, dogs, and human patients. Among the three retractors evaluated, the FK retractor offered the greatest versatility and overall exposure for robotic instrument maneuverability. Complete resection to negative surgical margins with excellent hemostasis and no complications was achieved in the live patient surgeries. Conclusions: TORS provided excellent three-dimensional visualization and instrument access that allowed successful surgical resections from cadaver models to human patients. TORS is a novel and minimally invasive approach to tongue neoplasms that has significant advantages over classic open surgery or endoscopic transoral laser surgery.