Fernández-Fernández Mario M, Montes-Jovellar Lourdes, Parente Arias Pablo Luis, Ortega Del Alamo Primitivo
Department of Otolaryngology, Hospital Universitario del Henares, Avda Marie Curie s/n, 28822, Coslada, Madrid, Spain.
Otolaryngology Head & Neck Surgery Department, MD Anderson International, c/Arturo Soria 270, 28033, Madrid, Spain.
Eur Arch Otorhinolaryngol. 2015 Dec;272(12):3785-91. doi: 10.1007/s00405-014-3423-6. Epub 2014 Dec 16.
The objective of this study is to describe and evaluate the feasibility of TransOral UltraSonic Surgery (TOUSS), a new endoscopic alternative to transoral robotic surgery for approaching pharyngeal and laryngeal tumours based on ultrasonic scalpel as a resection tool. This is a prospective study on 11 consecutive patients with pharyngeal and supraglottic carcinomas between December 2013 and August 2014. All tumours were resected transorally with 35 cm ThunderbeatTM. Exposure was achieved using GyrusTM FK-retractor and Olympus ENDOEYE Flex 5 mm 2D/10 mm 3D deflecting tip video laparoscopes. We evaluated tumour staging, surgical margins, surgical time, blood transfusions, tracheostomy, enteral feeding, postoperative pain and hospital stay. The operating room setup and procedure are described. This series comprised seven early and four locally advanced carcinomas. The mean setup for TOUSS and resection time were 16 and 70.9 minutes. No major intraoperative complications were identified. The average time of nasogastric feeding tube dependence (n = 9) was 13 days. Gastrostomy was performed in one patient. The average hospital stay was 14.3 days. Postoperative pain was satisfactory treated with nonsteroidal anti-inflammatory drugs. We have described TOUSS as a new feasible and intuitive procedure to approach endoscopically pharyngeal and supraglottic tumours, with good intraoperative conditions and functional outcomes.
本研究的目的是描述和评估经口超声手术（TOUSS）的可行性，这是一种新的内镜手术方法，可替代经口机器人手术用于治疗咽喉部肿瘤，该方法以超声刀作为切除工具。这是一项前瞻性研究，纳入了2013年12月至2014年8月期间连续收治的11例咽癌和声门上癌患者。所有肿瘤均经口使用35 cm ThunderbeatTM进行切除。使用GyrusTM FK牵开器和奥林巴斯ENDOEYE Flex 5 mm 2D/10 mm 3D偏转尖端视频腹腔镜实现暴露。我们评估了肿瘤分期、手术切缘、手术时间、输血情况、气管切开术、肠内营养、术后疼痛和住院时间。描述了手术室设置和手术过程。该系列包括7例早期癌和4例局部晚期癌。TOUSS的平均设置时间和切除时间分别为16分钟和70.9分钟。未发现重大术中并发症。鼻胃饲管依赖的平均时间（n = 9）为13天。1例患者进行了胃造口术。平均住院时间为14.3天。术后疼痛使用非甾体类抗炎药治疗效果满意。我们已将TOUSS描述为一种新的可行且直观的内镜治疗咽和声门上肿瘤的手术方法，术中条件良好且功能预后良好。
