Transoral robotic surgery in head and neck cancer
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memo https://doi.org/10.1007/s12254-020-00638-5
Transoral robotic surgery in head and neck cancer Andreas Strobl · Maximilian Hartl · Martin Burian
Received: 13 May 2020 / Accepted: 7 July 2020 © Springer-Verlag GmbH Austria, part of Springer Nature 2020
Summary Robotic surgery in the field of head and neck cancer was initiated at the beginning of this century. In the last decade, transoral robotic surgery (TORS) had to prove its oncological equivalence to standardised conservative treatment regimens like radiotherapy and radiochemotherapy and to other transoral or open surgical procedures. The amount of data on oncological efficacy, cost effectiveness and longterm outcomes has continued to increase over the last few years. The transoral approach enables minimally invasive tumour resection, which helps to minimize functional postoperative deficits. Compared with traditional concurrent radiochemotherapy (CRCT), the radiation dose is lower in the adjuvant setting and therefore helps to reduce long-term toxicities. Moreover, in case of absent risk factors in the histological specimen, it might be possible to avoid additional chemotherapy. Thus, long-term toxicities eventually caused by CRCT might be decreased. Keywords Oropharyngeal cancer · Laser surgery · Toxicities · Minimally invasive surgical procedures · HPV
Like in other surgical fields, the da Vinci robot (Intuitive Surgical Inc., Sunnyvale, CA, USA) pioneered the
A. Strobl · M. Hartl · M. Burian () Department of Otorhinolaryngology, Head and Neck Surgery, Ordensklinikum Linz, Barmherzige Schwestern, Seilerstätte 4, 4010 Linz, Austria [email protected] A. Strobl [email protected] M. Hartl [email protected]
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application of a robotic system in head and neck cancer patients. Since its introduction by O’Malley and Weinstein in 2006 [1], transoral robotic surgery (TORS) has become the second main pillar in minimally invasive head and neck surgery in addition to transoral laser microsurgery (TLM). While in Central Europe, transoral laser surgery was performed on a high quality standard with satisfying oncological results since the 1990s [2–4], concurrent radiochemotherapy was preferred in the majority of centres in the United States at this time [5]. The main argument for transoral minimally invasive surgery in early stages of mucosal squamous cell cancer (SCC) was the possible omission of adjuvant treatment or the lower radiation dose in the adjuvant setting compared to CRCT. On the other hand, the piecemeal technique, frequently necessary in TLM and described in detail by Steiner [6] was criticised by the “en bloc resection” community. Splitting the tumour during resection was against the paradigm of resections in safe margins, postulated by Halsted in the early 1990s. The essential use of the laryngoscope for TLM and the fact that the CO2 laser beam enables only cuts tangentially to the straight-line axis of the laser limited its use in bulky tumours. Resecting tumours of the base of the tongue belongs to the
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