Vicini Claudio, Leone Carlo Antonio, Montevecchi Filippo, Dinelli Elisa, Seccia Veronica, Dallan Iacopo
Oral Surgery Unit, Otolaryngology - Head and Neck Surgery Division, Department of Special Surgery, G.B. Morgagni L. Pierantoni Hospital, Forlì, Italy.
ORL J Otorhinolaryngol Relat Spec. 2014;76(2):98-104. doi: 10.1159/000359953. Epub 2014 Apr 30.
To assess the role of transoral robotic surgery (TORS) in managing failures of conventional transoral laser microsurgery (TLM) in cases with difficult laryngeal exposure.
Retrospective analysis of 3 patients with difficult laryngeal exposure treated with TORS. All 3 cases failed to be managed by conventional TLM after repeated attempts by experienced surgeons. In 2 cases, the initial disease was laryngeal cancer treated by a cricohyoidoepiglottopexy, with an obstructing residual epiglottis. The last case was a bilateral Reinke disease submitted to repeated TLM procedures, producing multiple supraglottic and glottic scars. In all cases, the difficult exposure was produced by a combination of concurrent elements including insufficient mouth opening, short and stiff neck, macroglossia and high-positioned larynx.
Two patients were exposed by means of a Davis Meyer mouth gag. The other patient was managed by a Feyh-Kastenbauer device. The key of the success was the possibility to work 'around the corner' (30° angle view) where straight alignment of the larynx was impossible.
Where possible, a TORS approach should be considered complementary to TLM in cases of very difficult or even impossible conventional transoral laryngoscopic approach.
评估经口机器人手术（TORS）在处理喉暴露困难病例中传统经口激光显微手术（TLM）失败情况时的作用。
对3例接受TORS治疗的喉暴露困难患者进行回顾性分析。所有3例患者经经验丰富的外科医生反复尝试后，均无法通过传统TLM进行处理。其中2例患者最初的疾病为喉癌，接受了环状舌骨会厌固定术，残留会厌造成阻塞。最后1例患者为双侧Reinke病，接受了多次TLM手术，导致声门上和声门多处瘢痕形成。在所有病例中，暴露困难是由多种因素共同导致的，包括张口受限、颈部短粗、巨舌症和高位喉。
2例患者通过Davis Meyer开口器暴露。另1例患者采用Feyh-Kastenbauer装置处理。成功的关键在于能够在无法直接直视喉部的情况下（30°视角）“绕过拐角”进行操作。
在传统经口喉镜检查非常困难甚至不可能进行的情况下，应尽可能考虑将TORS方法作为TLM的补充。
