Byeon Hyung Kwon, Duvvuri Umamaheswar, Kim Won Shik, Park Young Min, Hong Hyun Jun, Koh Yoon Woo, Choi Eun Chang
Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea.
J Craniofac Surg. 2013 Jul;24(4):1156-61. doi: 10.1097/SCS.0b013e318293f860.
Retropharyngeal lymph node (RPLN) metastases can occur from advanced head and neck malignancies. Surgical access to RPLNs can be challenging. Considering the more aggressive conventional approach methods, there is an increasing need for minimally invasive techniques. Applying transoral robotic surgery (TORS) to access the RPLN has never been reported in the literature. The purpose of this study was to describe our experience with transoral robotic RPLN dissection for oropharyngeal and hypopharyngeal squamous cell carcinomas. We conducted a retrospective review of TORS cases performed at Severance Hospital, a tertiary care medical center from December 2011 to July 2012. Demographic, clinicopathologic, and treatment characteristics were abstracted from the medical record as well as complications and were analyzed descriptively. A total of 5 TORS procedures with transoral robotic RPLN dissection have been performed at Severance Hospital. Of these, 4 patients were treated for oropharyngeal squamous cell carcinoma and 1 for hypopharyngeal squamous cell carcinoma. The mean operation time for TORS including the robotic RPLN dissection was 84 ± 18.5 minutes. The operation time included time for docking of the robotic arms (4.8 ± 1.3 minutes), console working time for primary tumor removal (50 ± 8.9 minutes), and console working time for RPLN dissection (29.2 ± 9.4 minutes). No patients experienced complications related to the transoral robotic RPLN dissection. Transoral robotic RPLN dissection is a feasible approach for accessing retropharyngeal lymph nodes. This particular operative technique can serve as a minimal invasive surgery in removing pathologic RPLNs.
咽后淋巴结（RPLN）转移可发生于晚期头颈部恶性肿瘤。手术进入RPLN具有挑战性。考虑到传统方法更具侵袭性，对微创技术的需求日益增加。文献中从未报道过应用经口机器人手术（TORS）进入RPLN。本研究的目的是描述我们经口机器人RPLN清扫治疗口咽和下咽鳞状细胞癌的经验。我们对2011年12月至2012年7月在三级医疗中心Severance医院进行的TORS病例进行了回顾性研究。从病历中提取人口统计学、临床病理和治疗特征以及并发症，并进行描述性分析。Severance医院共进行了5例经口机器人RPLN清扫手术。其中，4例患者接受口咽鳞状细胞癌治疗，1例接受下咽鳞状细胞癌治疗。包括机器人RPLN清扫在内的TORS平均手术时间为84±18.5分钟。手术时间包括机器人手臂对接时间（4.8±1.3分钟）、切除原发肿瘤的控制台操作时间（50±8.9分钟）和RPLN清扫的控制台操作时间（29.2±9.4分钟）。没有患者出现与经口机器人RPLN清扫相关的并发症。经口机器人RPLN清扫是进入咽后淋巴结的一种可行方法。这种特殊的手术技术可作为切除病理性RPLN的微创手术。
