Table 5.
Preclinical and clinical studies relating to the use of robotics in trans-oral robotic surgery (TORS) for a plastic surgery application.
| Reference | Year | Study design | Operations performed | Outcomes reported |
|---|---|---|---|---|
| Preclinical studies | ||||
| Selber et al. (54) | 2010 | Coffee cup models, pig cadavers, human cadavers | TORS free radial forearm flap reconstruction of oropharyngeal defect (N = 2) | Successful reconstruction of the oropharynx by trans-oral robotic flap inset and microvascular anastomosis |
| Robotic microvascular anastomosis | ||||
| Smartt et al. (55) | 2013 | Human cadaver | Superiorly based posterior pharyngeal flap transfer (N = 3) | Successful transfer of posterior pharyngeal flaps, with mean surgical time of 113 min. Technically, the learning curve for using the robot telemanipulator was steep |
| There was no damage to adjacent structures | ||||
| Clinical studies | ||||
| Desai et al. (56) | 2008 | Case cohort, retrospective analysis | Mucosal flap and pyriform sinus flap reconstructions (N = 7) | No intra- or postoperative complications, one patient required tracheostomy |
| Mukhija et al. (57) | 2009 | Case series | Radial forearm fasciocutaneous free-flap harvest and reconstruction of oral cavity (N = 2) | Successful positioning of the flap, shorter operating time compared to conventional techniques, shorter hospital stay compared to mandibulotomy approach |
| Selber (58) | 2010 | Case series | Free-flap reconstruction of oropharynx (radial forearm free-flap, anterolateral thigh flap, facial artery, myomucosal flap), primary closure after tumor resection, and microvascular anastomosis (N = 5) | Better access and improved precision within the oropharynx, compared to conventional tecnhiques |
| Successful microvascular anastomosis | ||||
| Garfein et al. (59) | 2011 | Case report | Radial forearm flap for reconstruction of the tounge base, vallecula and pre-epiglotic space, due to soft tissue and hyoid radionecrosis (N = 1) | The patient passed a swallow evaluation after 1 week, and started an oral diet 8 days after the operation |
| There was good function showed by video oesophagram 6 week postoperatively | ||||
| Genden et al. (60) | 2011 | Prospective non-randomized case–control study | Free-flap reconstruction of oropharynx—sternocleidomastoid free-flap, mucosal mulscular flaps and pharyngoplasty (N = 30) | Equivalent rates of loco-regional and distant control of malignancy and better short-term eating ability, compared to conventional techniques |
| No major long term sequelae | ||||
| Genden et al. (61) | 2011 | Prospective non-randomized case–control study | Musculomucosal advancement flap pharyngoplasty (N = 30) | Postoperatively, patients regained excellent function, with near-normal scores on the Functional Oral Intake Scale and Performance Status Scale for Head and Neck Cancer Patients at 1 year after surgery |
| Radial forearm free-flap reconstruction | ||||
| Bonawitz and Duvvuri (62) | 2012 | Case cohort, retrospective | Free-flap oropharyngeal reconstruction, with microvascular anastomoses in the tongue base and soft palate (N not reported) | No major complications and no flap loss |
| Longfield et al. (63) | 2012 | Case series | Robotic reconstruction after resection squamous cell carcinoma of the oropharynx using local and distant free-flaps, with microvascular anastomoses (N not reported) | Patients can be safely reconstructed (locally or with free tissue transfer) robotically after TORS |
| Bonawitz and Duvvuri (64) | 2013 | Case series | Local random transposition flaps from buccal mucosa, the hard palate or the pharyngeal wall (N not reported) | No major complications |
| Facial artery musculomucosal (FAMM) flap for larger defects of the soft palate | ||||
| Bonawitz and Duvvuri (65) | 2013 | Case cohort, retrospective | FAMM flap reconstruction after removal of malignant tumors of the soft palate (N = 5) | No major complications, no flap loss |
| Duvvuri et al. (66) | 2013 | Case cohort, retrospective | Oropharyngeal reconstruction with FAMM free-flaps, ALT free-flaps, radial forearm flaps and uvular flaps (N = 12) | No major complications, some minor flap dehiscence, two revision procedures needed (one fistula, one bulky flap) |
| Hans et al. (67) | 2013 | Case series | Radial forearm free-flap reconstruction after resection of hypopharyngeal carcinoma (N = 2) | A complication of a neck hematoma requiring draining under general anesthesia, no fistulae |
| Park et al. (68) | 2013 | Case series, prospective study | Radial forearm muscle free-flap reconstruction of oropharynx (N = 7) | No surgery-related complications of infections, viable and functioning free-flaps in all patients, one hundred percent of patients happy with postoperative appearance and could tolerate an oral diet |
| Song et al. (69) | 2013 | Case series | Robotic ablation surgery, free-flap reconstruction (radial forearm free-flaps, anterolateral thigh flap), and microvascular anastomosis (N = 5) | Flap insetting and microanastomoses were achieved using a specially manufactured robotic instrument |
| No complications | ||||
| De Almeida et al. (70) | 2014 | Case cohort, retrospective | Velopharyngoplasty reconstructinos with local flaps alone, regional and free-flaps, and secondary healing (N = 92) | Good swallowing outcomes, no carotid artery ruptures |
| Byeon et al. (71) | 2015 | Case series | Reconstruction and lymph node dissection for head and neck malignancy (N = 37) | Good cosmetic outcomes and no major complications |
| Perrenot et al. (72) | 2014 | Case series | Infra-hyoid myocutaneous flap reconstructions (N = 8) | Good esthetic results |
| One case required re-operating due to hemostasis | ||||
| No other complications | ||||
| Seven out of eight patients tolerated oral feeding postoperatively | ||||
| Lai et al. (73) | 2015 | Case cohort | Free radial forearm fasciocutaneous flap reconstruction after resection of oropharyngeal cancer (N = 5) | All reconstructive surgeries were successful, with no flap failure or take-backs, no wound infections and no fistulae |
| Meccariello et al. (74) | 2016 | Case report | Resection and reconstruction, with temporalis muscle flap, of squamous cell carcinoma of the lateral oropharyngeal wall extending into the soft palate (N = 1) | Restoration of a competent velopharyngeal sphincter, with water-tight seal between pharynx and neck |
| Timely healing and enhanced postoperative functional results | ||||
| Gorphe et al. (75) | 2017 | Non-randomized phase II muti-center prospective trial | FAMM and free ALT flap reconstructions of the oropharynx (N = 9) | Robotic surgery proved feasible, and further technological progress in developing robotic systems specifically for trans-oral surgery will be of benefit to patients |
| Biron et al. (76) | 2017 | Case–control series | Radial forearm free-flap reconstruction after excision of oropharyngeal squamous cell carcinoma (N = 18) | Significantly shorter admission duration and fewer postoperative complications |
The number of procedures carried out in each study is documented and represented as N number.