Moore Eric J, Van Abel Kathryn M, Olsen Kerry D
Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A.
Laryngoscope. 2017 Jan;127(1):122-126. doi: 10.1002/lary.26148. Epub 2016 Jul 5.
OBJECTIVES/HYPOTHESIS: Transoral surgery (TOS) is commonly performed in a supine patient with an oral retractor. Paradoxically, this strategy can create difficulty with visualizing and accessing pathology at the base of tongue, inferior pharynx, and larynx. We investigate the feasibility of TOS with the patient in the seated position.
Pilot study.
TOS utilizing the da Vinci Robotic Surgical Xi and Si systems (Intuitive Surgical, Sunnyvale, CA) was performed on a fresh cadaver placed in both the traditional supine position and the seated position. Transoral robotic surgery (TORS) in the seated position was then performed on two patients for a supraglottic laryngectomy and a hypopharyngeal carcinoma resection.
Visualization of the entire upper aerodigestive tract was possible in the cadaver and two patients in the seated position. The Si was superior for docking, instrumentation, and assistant access. The minimum operating table height is critical for successful access. Advantages of this position included increased posterior airway/operative space by approximately 2 cm, ability to manipulate the surgical field (nonrigid retraction), and improved visualization. Surgical procedures were completed in comparable times compared with standard TORS procedures. There were no complications related to seated TORS.
TORS in the seated position was both safe and effective in this pilot study. It allows the surgeon to optimally operate in the inferior pharynx and larynx without the limitation of line of site access and visualization. A paradigm shift in patient positioning during TOS may allow improved surgical access and even greater patient candidacy. Further clinical investigation into this technique is warranted.
NA Laryngoscope, 127:122-126, 2017.
目的/假设：经口手术（TOS）通常在仰卧位患者身上使用口腔牵开器进行。矛盾的是，这种策略在可视化和触及舌根、下咽和喉部的病变时可能会产生困难。我们研究了患者处于坐位时经口手术的可行性。
初步研究。
利用达芬奇机器人手术Xi和Si系统（直观外科公司，加利福尼亚州桑尼维尔市）对处于传统仰卧位和坐位的新鲜尸体进行经口手术。然后对两名患者进行坐位经口机器人手术（TORS），分别用于声门上喉切除术和下咽癌切除术。
在尸体及两名坐位患者中均能够可视化整个上呼吸道消化道。Si系统在对接、器械操作和助手进入方面更具优势。手术台的最低高度对于成功进入至关重要。该体位的优点包括后气道/手术空间增加约2厘米、能够操控手术视野（非刚性牵开）以及改善可视化。与标准TORS手术相比，手术时间相当。坐位TORS未出现相关并发症。
在这项初步研究中，坐位TORS安全有效。它使外科医生能够在下咽和喉部进行最佳操作，而不受视线进入和可视化的限制。经口手术期间患者体位的范式转变可能会改善手术入路，甚至增加患者的手术适应症。有必要对该技术进行进一步的临床研究。
NA《喉镜》，2017年，第127卷，第122 - 126页
