1 TransOral Robotic Surgery (TORS) From the Robotics Lab to the Bedside GREGORY S. WEINSTEIN BERT W. O'MALLEY, JR. JASON A. DIAZ   Introduction This book is far from being all encompassing, but we have filled it with the "tips" and "surgical details" that we believe will enhance the success of those performing TransOral Robotic Surgery (TORS). Although we embarked on this project shortly after initiating our prospective human clinical trial, we elected to wait to complete this work so we could s -- 2 Preoperative Evaluation for TransOral Robotic Surgery (TORS) JOSHUA H. ATKINS GREGORY S. WEINSTEIN BERT W. O'MALLEY, JR JEFF E. MANDEL HARRY QUON   Introduction A critical factor in achieving successful functional and oncologic outcomes is the appropriate triage of patients for TransOral Robotic Surgery (TORS). Just as chemotherapy and radiation trials for cancers of the head and neck have eligibility and ineligibility requirements based on the extent of the cancer and other factors such as th -- 3 Instrumentation and Supplies BERT W. O'MAllEY, JR. GREGORY S. WEINSTEIN   Introduction The instrumentation and surgical supplies needed to perform TransOral Robotic Surgery (TORS) has become standardized at the University of Pennsylvania. Although it is typical for equipment lists for cases to evolve over time with the addition of new instruments and removal of less useful ones, there has been very little change to the limited instruments and accessory supplies used for our TORS cases over the.

4 Patient Positioning and Setup Utilizing the da Vinci Robotic System A Surgeon's Perspective GREGORY S. WEINSTEIN WALEED M. ABUZEID KHURRAM KHAN BERT W. O'MALLEY, JR.   Introduction The initial goals of the head and neck robotic surgery research program at the University of Pennsylvania began in the laboratory setting using mannequin and cadaver models with the goal of overcoming two issues that thwarted prior efforts in attempting transoral robotic approaches: (1) robot base positioning relati -- 5 The Critical Role of the Operating Room Nursing Team JOSEPH W. READINGER SAMANTHA DAVIS LAURA KELCHNER   Introduction Although it is important that one core team manages the TransOral Robotic Surgery (TORS) patient and procedure, this chapter discusses the details of circulating nurse and scrub technician in a transoral da Vinci® robotic surgical case for a registered nurse (RN) or a scrub technician. In general, one formal day of training for nurses is required to learn the intricate details -- 6 The Critical Roles of the Bedside Surgical Assistant in TransOral Robotic Surgery (TORS) Optimizing Patient Safety and Achieving Hemostasis NEIL G. HOCKSTEIN GREGORY S. WEINSTEIN BERT W. O'MALLEY, JR.   Introduction The incorporation of a robot into transoral surgery requires unique strategies to optimize patient safety and ensure that device malfunction or misuse does not result in adverse patient outcome. Clinical use of a surgical robotic in abdominopelvic and thoracic surgery has been perf.

7 Transoral Anatomy in the Context of TORS NIELS KOKOT BERT W. O'MALLEY, JR GREGORY S. WEINSTEIN   Introduction Head and neck surgeons classically are taught anatomy and surgical techniques through external approaches, and subsequently the external anatomy of the neck and laryngopharynx becomes well known. Although TORS offers many advantages over traditional open approaches, these robotic procedures involve navigating the anatomy from "inside-out," in a way that may be unfamiliar to many head a -- 8 Robotic Radical Tonsillectomy GREGORY S. WEINSTEIN BERT W. O'MALLEY, JR. HARRY QUON   Introduction In this chapter, we present the technique of TORS radical tonsillectomy for the primary surgical management of tonsillar cancer. A review of the historical literature indicates that, over the past 150 years, the pendulum has swung between surgical and nonsurgical management of tonsillar cancer.1,2 Although numerous statements in the literature indicate that nonsurgical treatment is now the mainst -- 9 Robotic Tongue Base Resection BERT W. O'MALLEY, JR. GREGORY S. WEINSTEIN WALEED M. ABUZEID KHURRAM KHAN HARRY QUON   Introduction The national trends for the management of oropharyngeal squamous cell carcinoma, according to an analysis by Chen et al1 in which the National Cancer Database (NCDB) was analyzed for patients treated between 1985 and 2001 was that approximately onethird of patients were treated with primary surgery throughout the period. Chen et al1 also found a decline in the numbe.

10Robotic Supraglottic Partial Laryngectomy GREGORY S. WEINSTEIN BERT W. O'MALLEY, JR. WALEED M. ABUZEID KHURRAM KHAN HARRY QUON   Introduction The management of supraglottic carcinoma has evolved significantly since the first reported total laryngectomy in 1873. Despite providing highly effective local disease control, total laryngectomy severely impacted functional outcome in patients. As a result, primary radiation therapy was introduced with the aim of preserving laryngeal structures, thereb -- 11 Robotic Resection of Parapharyngeal Space Tumors BERT W. O'MALLEY, JR. GREGORY S. WEINSTEIN FERNANDO D. LEONHARDT HARRY QUON   Introduction Tumors of the parapharyngeal space (PPS) are uncommon and only 0.5% of head and neck neoplasms occur in this area.1,2 The PPS, which is situated lateral to the pharynx, may be viewed as an inverted pyramid with its base at the cranial base and its apex at the greater cornu of the hyoid bone (Fig 11-1). The greater wing of the sphenoid bone with the forame -- 12Robotic Tongue Base Reduction (TBR) and Supraglottoplasty (SGP) for Obstructive Sleep Apnea CLAUDIO VICINI FILIPPO MONTEVECCHI GIULIA TENTI PIETRO CANZI IACOPO DALLAN ERICA THALER   Background and Rationale Obstructive sleep apnea hypopnea syndrome (OSAHS) is an underestimated but significant social and health problem.1 From a therapeutic point of view, continuous positive airway pressure (CPAP) ventilation is widely considered the gold standard.2 Alternative options include a number of surgic.

13TransOral Robotic Surgery: Glottic Procedures BERT W. O'MALLEY, JR. GREGORY S. WEINSTEIN WALEED M. ABUZEID KHURRAM KAHN HARRY QUON   Introduction Surgery of the larynx has evolved from effective, but functionally devastating, total laryngectomy to a variety of organ-preserving open surgical procedures and endoscopic laser surgery. In recent years, transoral laser microsurgery (TLM) has achieved widespread popularity for the treatment of benign and malignant lesions at the glottis level.1-14 Ho -- 14Skull Base TORS, Robotic Cranial Base Surgery, and TORS Nasopharyngeal Resection BRAD C. LEGA JOHN Y. K. LEE JASON G. NEWMAN M. SEAN GRADY GREGORY S. WEINSTEIN BERT W. O'MALLEY, JR. JASON A. DIAZ   Introduction The introduction of endoscopic surgery in the last 20 years resulted in a paradigm shift in how sinus and now skull base surgery is performed. Instead of having to make direct eye contact with the surgical site and anatomic structures, surgeons observe and operate form a video monitor a -- 15Postoperative Management: Optimizing Postsurgical Clinical Outcomes BERT W. O'MALLEY, JR. GREGORY S. WEINSTEIN RAY GERVACIO F. BLANCO DEVRAJ BASU SHANNON MURRAY   Management of the Postoperative Airway At the end of the case, the surgeon must decide if the patient will be extubated or remain intubated. If the patient is to undergo immediate extubation, we request that the anesthesiologist does not use an oral airway as this may create bleeding in the tongue base or vallecula area. If there is.

16Special Considerations for Radiation Therapy Following TransOral Robotic Surgery (TORS): Part 1. Background and Rationale HARRY QUON GREGORY S. WEINSTEIN BERT W. O'MALLEY, JR.   Treatment Paradigm Implications of TORS for Oropharyngeal Carcinomas In recent years, technologic advancements have facilitated the safer consideration of surgical treatment options for carcinomas of the oropharynx. These include the transoral laser and robotic (TORS) resection techniques.1-5 These techniques offer the.