Division of Head and Neck Surgery, Department of Surgery, University of California San Diego, San Diego, CA, USA.
Division of Minimally Invasive Surgery, Department of Surgery, University of California San Diego, San Diego, CA, USA.
Surg Endosc. 2021 Aug;35(8):4857-4864. doi: 10.1007/s00464-021-08420-2. Epub 2021 Mar 12.
We investigated a novel minimally invasive surgical platform for use in the oropharynx, hypopharynx, and larynx for single-port transoral surgery used in concert with standard transoral laryngeal and pharyngeal instrumentation.
The preclinical investigational device by Fortimedix Surgical B.V. (Netherlands) features two channels for manually controlled flexible articulating surgical instruments. A third central channel accepts both rigid and flexible endoscopes. The system is coupled to a standard laryngoscope for transoral access. In three cadaver models, we evaluated the surgical capabilities using wristed grasping instruments, microlaryngeal scissors, monopolar cautery, and a laser fiber sheath. Procedures were performed within the oropharynx, supraglottis, glottis, subglottis, and hypopharynx.
Within the oropharynx, we found adequate strength, range of motion, and dexterity to perform lateral oropharyngectomy and tongue base resection. Within the larynx, visualization was achieved with a variety of instruments including a flexible, 0° and 30° rigid endoscope. The glottis, supraglottis, pyriform sinuses, post-cricoid space, and esophageal inlet were readily accessible. Visualization and manipulation of grasping, laser, and monopolar cautery instruments were also possible within the subglottis. Instrument reach and accuracy facilitated completion of a delicate micro-flap on the true vocal fold. Other procedures included vocal fold resection, cricopharyngeal myotomy, and resection of subglottic mucosa.
From this initial proof of concept experience with this novel platform, we found a wide range of procedures within the oropharynx, larynx, and hypopharynx to be feasible. Further work is needed to evaluate its applicability to the clinical setting. The ability of this platform to be used with conventional instrumentation may provide an opportunity for complex transoral surgery to be performed in a facile manner at greatly reduced cost.
我们研究了一种新型的微创手术平台，用于经口咽、下咽和喉进行单端口经口手术，与标准的经口喉和咽仪器配合使用。
由 Fortimedix Surgical B.V.（荷兰）开发的临床前研究设备具有两个用于手动控制灵活铰接手术器械的通道。第三个中央通道可容纳刚性和柔性内窥镜。该系统与标准喉镜一起用于经口进入。在三个尸体模型中，我们使用腕式抓握器械、微型喉剪、单极电烙和激光纤维鞘评估了手术能力。手术在口咽、声门上区、声带、声门下区和下咽进行。
在口咽，我们发现有足够的力量、运动范围和灵巧性来进行侧口咽切除术和舌根切除术。在喉内，通过各种器械（包括柔性、0°和 30°刚性内窥镜）实现了可视化。声带、声门上区、梨状窦、环后区和食管入口易于接近。在声门下区也可以实现抓握、激光和单极电烙器械的可视化和操作。器械的可达性和准确性有助于完成真声带的精细微瓣。其他手术包括声带切除术、环杓肌切开术和声门下黏膜切除术。
从这个新型平台的初步概念验证经验来看，我们发现该平台在口咽、喉和下咽范围内可以进行广泛的手术。需要进一步的工作来评估其在临床环境中的适用性。该平台能够与常规仪器一起使用，为以简单的方式进行复杂的经口手术并降低成本提供了机会。
