Jolissaint Marlon, Marggraf Maximilian, Diktanaite Dovile
Klinik für Anästhesie, Luzerner Kantonsspital Zentrumsspital, Luzern, Schweiz.
University of Luzern, Luzern, Schweiz.
Anaesthesiologie. 2025 Jul 21. doi: 10.1007/s00101-025-01566-x.
Transoral robot-assisted surgery (TORS) enables minimally invasive procedures in the areas of the mouth, palate, pharynx, larynx and tonsils. It offers numerous advantages such as enhanced precision, improved access and reduced surgical trauma compared to traditional, more invasive techniques; however, TORS also presents new anesthesiological challenges, particularly concerning airway management, anesthesia management and perioperative care. These aspects are the focus of this review. A key issue in TORS is airway management as many patients present with risk factors for a difficult airway, while at the same time it is essential to minimize obstruction of the surgical field and access. Several options are available for securing the airway during TORS. This article outlines and discusses the advantages and disadvantages of the various techniques. Special attention is paid to a novel ultra-thin endotracheal tube known as the Tritube©, which thanks to its slim design opens up new surgical and anesthesiological possibilities. The associated technique of flow-controlled ventilation (FCV) is discussed and compared to more established ventilation methods such as volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV). This article aims to provide an overview of anesthesia management in TORS, highlight potential risks and outline strategies to mitigate them.
经口机器人辅助手术（TORS）能够在口腔、腭、咽、喉和扁桃体区域进行微创手术。与传统的、侵入性更强的技术相比，它具有诸多优势，如精度更高、手术入路更佳以及手术创伤更小；然而，TORS也带来了新的麻醉学挑战，尤其是在气道管理、麻醉管理和围手术期护理方面。这些方面是本综述的重点。TORS中的一个关键问题是气道管理，因为许多患者存在困难气道的风险因素，同时必须尽量减少对手术视野和手术入路的阻碍。在TORS期间确保气道安全有多种选择。本文概述并讨论了各种技术的优缺点。特别关注一种名为Tritube©的新型超薄气管导管，由于其纤细的设计，开辟了新的手术和麻醉学可能性。文中讨论了流量控制通气（FCV）的相关技术，并将其与更成熟的通气方法如容量控制通气（VCV）和压力控制通气（PCV）进行了比较。本文旨在概述TORS中的麻醉管理，突出潜在风险并概述减轻这些风险的策略。
