nasopharynx access by minimally invasive transoral robotic surgery： anatomical study -凯发官网入口

vol.:(0123456789) 1 3journal of robotic surgery https://doi.org/10.1007/s11701-018-0804-7original articlenasopharynx access by minimally invasive transoral robotic surgery: anatomical studyamine harichane 1,4  · dorian chauvet 2  · stéphane hans 3received: 21 november 2017 / accepted: 12 march 2018 © springer-verlag london ltd., part of springer nature 2018abstractthis study was made to assess the possibilities and limits of minimally invasive transoral approach to the nasopharynx using the da vinci surgical robot. it was conducted on eleven corpses, without need for palatine split; using surgical robots da vinci models s hd and si hd. we have def i ned “anatomical key landmarks” on all sides of the nasopharynx, to conf i rm our hypothesis. all of the nasopharynx could be visualized and transorally reached by the robot with a validation of all the key landmarks. the advantages and shortcomings of this technique were discussed, as well as the ability to use those results on human subjects. this study allowed us to show the possibility to access the nasopharynx by minimally invasive transoral robotic surgery. this new technique opens a new fi eld for surgery of the skull base or the nasopharynx.keywords transoral robotic surgery · nasopharynx · transoral · robot · minimally invasive surgeryintroductionclassically, radiotherapy or concurrent chemoradiotherapy are the most common treatments in nasopharynx cancer, depending on its stage. in case of local recurrence or fail-ure, which af f ects approximately 18–58% of patients [1], re-irradiation protocols exist but with important morbidity: osteoradionecrosis, neurological injuries, trismus, chronic otitis media or radio-induced malignancies. in some teams, surgical access of the nasopharynx is processed through external [2, 3] or endonasal [4] approaches, with a major risk of complications. the external path is more aesthetically of f ensive since it creates a skin scar, but allows a better con-trol of the deep invasion of the parapharyngeal space. this is the reason why the endonasal way has been used for the last 20 years, using optical instruments to perform some resections with a minimal invasive approach. this technique requires two operators and allows an excellent visualization in two dimensions, it also creates new dif f i culties: the dif f i -culty to achieve complex gestures in a conf i ned location like the nasal cavity or the nasopharynx and the impossibility to stitch. the procedure also generates morbidity, especially because of the requirements to perform resections in the nasal cavity (septum, turbinates) with functional respiratory after-ef f ects.robotic surgery with the da vinci system in otorhino-laryngology [5] was developed in 2005 after its use in other surgical specialties (urology, gynaecology, heart surgery…). the robot used a so called minimally invasive surgery with several advantages: suppression of physiological tremor, use of both hands allowing many dif f erent movements through a small incision or even without any opening, visualization in three dimensions; all of this without lengthening classical operating times. thus, the surgical management of cancers of the upper aero-digestive tract is amended, including the reduction of morbidity related to the procedure since the resumption of normal feeding can be carried out sooner while the hospital stay is convergingly shorter [6]. the safety of transoral robotic surgery (tors) in some areas such electronic supplementary material the online version of this article (https ://doi.org/10.1007/s1170 1-018-0804-7) contains supplementary material, which is available to authorized users. * amine harichane 1 department of otorhinolaryngology-head and neck surgery, paris pierre et marie curie university, paris, france2 department of neurosurgery, fondation ophtalmologique adolphe de rothschild, paris, france3 department of otorhinolaryngology-head and neck surgery, ap-hp hôpital européen georges pompidou, paris descartes university, paris, france4 montrouge, france