S. Van Der Vorst

Transoral robotic surgery (TORS) with the Medrobotics Flex™ System: first surgical application on humans.

Head and neck surgery can be fraught with difficulties in accessing the pharynx and larynx. Minimally invasive surgery has developed with the recent advances in technology. Currently, we have a variety of high-definition multichannel videoendoscopes and robots in our armamentarium. We present our experience in a new robotic surgical system—’The Medrobotics Flex™ System’ at our tertiary referral unit. We aimed to assess the safety, functionality and ease of use of this new device in this prospective study. Thus far, this is the first study in live human subjects who have undergone surgery for the following conditions: (1) obstructive sleep apnoea involving the base of tongue, the tonsil and the velum; (2) vocal fold polyp; (3) carcinoma of the lateral edge of the tongue. There were no complications in our series and the system provided good visualisation and access to these subsites without compromising safety or success. In summary, we found the Medrobotics Flex™ System to have certain other advantages including ease of set up and use besides being reliable and safe.

Response to letter to Editor: “The clinical course of recurrent respiratory papillomatosis after the use of cidofovir is influenced by multiple factors” by Michel R. M. San Giorgi et al.

We would like to thank Prof F. G. Dikkers and his team from the Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Groningen, The Netherlands, for their comments [1] and interests in our paper [2]. We have found a lot of interest on your papers [3] and about HPV typing in all patients. As you stated: ‘‘Younger patients with HPV11 and older patients with HPV6 experience a worse clinical course of RRP’’. In our study, typing is different for all the cases, but Hpv 16 has been excluded. In our network, some labs do not propose the typing of HPV 6 or 11. As you reported in another study [4], ‘‘Gastroesophageal reflux disease and asthma negatively influence the course of RRP’’. In our series, patients had no special comorbidities. We are used to give PPI in the postop care of all our patients after microsurgery to prevent influence of reflux on healing whatever the lesion: polyp and cysts. Anyway cidofovir is only efficient against the virus. We also believe that ‘‘the younger the age of onset, the worse the clinical course of the disease will be’’ [1]. In our study, we have excluded young patients (JORRP), and all our cases were young adults (AORRP). All the patients developed the disease in adulthood. We are used to inject the cidofovir for all our cases. In young adults, we started immediately giving the drug; we believe that the disease is less aggressive than in children, and that combining cidofovir and surgical ablation, the disease could be controlled after a few procedures, what is much more difficult to accomplish in children [2]. Many cases were treated elsewhere without cidofovir that made the difference (83.9 % complete response). The combination of Digital scanning CO2 laser ablation and Cidofovir can lead to a complete remission in young adults affected by laryngeal RRP, showing safety and great efficacy after few intralesional applications, mean of 4.2 (1–14), and decreasing the rate of surgery. Some cases are years old followed-up (38.7 % of cases) and some others months old (58 % of cases). This is a series statiscally treated. Concluding, we do believe that cidofovir made the difference.

La chirurgie robotique en cancérologie ORL

RésuméLa chirurgie robotique en cancérologie ORL est une discipline récente et en évolution constante. La prise en charge thérapeutique des cancers ORL passe actuellement par une stratégie non chirurgicale dite de préservation d’organe. La chirurgie quand elle est retenue peut être en première intention ou dans le cadre d’une chirurgie de rattrapage. Elle s’effectue par voie transcutanée ou transorale, et dans ce cas l’apport du robot est souligné. Nous passerons en revue les acquis actuels publiés pour faire le point avec notre expérience sur les indications actuelles de ce mode opératoire, les avantages, les inconvénients, les développements futurs ainsi que les attentes de l’utilisateur avisé.AbstractTransoral robotic surgery (TORS) in Head and Neck oncology is a recent technical option with continued refinements. The management of head and neck cancer is currently based on organ preservation strategy. Surgery when required can be a first-line or as part of a salvage surgery. It is performed by open neck approach or transorally. In the case of a transoral surgery, the contribution of the robot is outlined. In this article, we have reviewed the existing published data and based on our expertise provided to the reader the evidence about the role of TORS for head and neck cancer, current indications for this procedure, advantages, disadvantages future developments as well as the user’s expectations.