Department of Otorhinolaryngology & Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India.
Department of Otorhinolaryngology & Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India.
Oral Oncol. 2022 Jan;124:105643. doi: 10.1016/j.oraloncology.2021.105643. Epub 2021 Dec 11.
INTRODUCTION/BACKGROUND: With the advent of TransOral Robotic Surgery (TORS) the ease of transoral procedures has been dramatically improved. TORS is already established for its feasibility, functional and oncological outcomes for selected lesions of oral cavity, oropharynx and laryngopharynx. This study reports on preliminary results with TransOral UltraSonic Surgery (TOUSS) for oncologic resections of oral cavity, oropharyngeal and supraglottic malignancies.
Eighteen patients with malignancies of oral cavity, oropharynx and supraglottis underwent TOUSS with simultaneous neck dissection and adjuvant therapy as indicated, from January 2018 to April 2019. Essential equipment included the FK-retractor (Gyrus Medical, Tuttilngen, Germany) for TransOral exposure, the Olympus ENDOEYE Flex 5 mm 2D/10 mm 3D deflecting tip video laparoscopes, and 35 cm long ultrasonic harmonic scalpel (Thunderbeat). Parameters evaluated include tumor staging, mouth opening, TOUSS setup time, TOUSS primary removal time, surgical margins, blood transfusions, tracheostomy, postoperative complications, enteral feeding and resumption of oral diet, duration of hospital stay, and survival outcomes.
Eighteen patients underwent complete TransOral UltraSonic Surgery (TOUSS), with simultaneous unilateral or bilateral neck dissection. No procedure was abandoned intraoperatively due to difficulty in extirpation of the tumor. Margins were negative for ten patients (55.6%), close in five (27.8%), and positive in three patients (16.7%). Average TOUSS set-up time was 22.5 min (range, 10-30 min) and average TOUSS primary tumor removal time was 35.3 min (range, 15-60 min). Patients started tolerating oral feeds even in the second post op day (mean 6 days), and transitioning to complete oral feeds with removal of the nasogastric tube was achieved in all (mean, 16 days). The average hospital stay was 7.4 days (range 2-16 days). Secondary hemorrhage occurred in two cases and required an emergency tracheostomy and ligation of lingual artery. Minor cervicopharyngeal fistula occurred in four cases and settled in all with conservative non-surgical treatment. Overall survival at 3 years was 70.5%, and disease-specific survival was 94.4%.
TransOral UltraSonic Surgery (TOUSS) is a safe and sound alternative method of endoscopic surgical treatment of oral cavity, oropharynx and supraglottic neoplasms. Advantages of this technique include faster resection time, intraoperative assistance from Narrow Band Imaging, easy affordability compared to TORS, and excellent functional outcomes.
简介/背景：随着经口机器人手术（TORS）的出现，经口手术的便利性得到了显著提高。TORS 已经因其在口腔、口咽和喉咽的选定病变中的可行性、功能和肿瘤学结果而得到确立。本研究报告了经口超声手术（TOUSS）用于口腔、口咽和会厌上区恶性肿瘤的肿瘤切除术的初步结果。
自 2018 年 1 月至 2019 年 4 月，18 例口腔、口咽和会厌上区恶性肿瘤患者接受了 TOUSS 手术，同时根据需要进行了颈部清扫术和辅助治疗。基本设备包括 FK-拉钩（德国图廷根的 Gyrus Medical）用于经口暴露、奥林巴斯 ENDOEYE Flex 5mm 2D/10mm 3D 偏转尖端视频腹腔镜和 35cm 长的超声谐波手术刀（Thunderbeat）。评估的参数包括肿瘤分期、张口度、TOUSS 设置时间、TOUSS 原发性切除时间、手术切缘、输血、气管切开术、术后并发症、肠内喂养和恢复口服饮食、住院时间和生存结果。
18 例患者均成功完成经口超声手术（TOUSS），同时进行单侧或双侧颈部清扫术。由于肿瘤切除困难，没有一例手术在术中被放弃。10 例（55.6%）患者的切缘为阴性，5 例（27.8%）为接近，3 例（16.7%）为阳性。平均 TOUSS 设置时间为 22.5 分钟（范围 10-30 分钟），平均 TOUSS 原发性肿瘤切除时间为 35.3 分钟（范围 15-60 分钟）。患者甚至在术后第二天就开始耐受口服喂养（平均 6 天），所有患者都在第 16 天成功地通过移除鼻胃管过渡到完全口服喂养。平均住院时间为 7.4 天（范围 2-16 天）。2 例发生继发性出血，需要紧急气管切开和舌动脉结扎。4 例发生小的颈咽瘘，所有病例均经保守非手术治疗治愈。3 年总生存率为 70.5%，疾病特异性生存率为 94.4%。
经口超声手术（TOUSS）是一种安全有效的内镜治疗口腔、口咽和会厌上区肿瘤的方法。该技术的优点包括切除时间更快、术中窄带成像的辅助、与 TORS 相比更容易负担得起，以及出色的功能结果。
