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Transoral laser microsurgery: feasibility of a new exoscopic HD-3D system coupled with free beam or fiber laser

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Abstract

In the last decades, new technological devices and instruments have been developed to overcome the technical limits of transoral laser microsurgery. The recent introduction of 3D endoscopy seems to be a promising tool in the field of diagnostic and operative laryngology as an alternative to the traditional microlaryngoscopy. Our work aims to present a novel transoral microsurgical setting that expands the use of exoscopic systems (in this case the VITOM® 3D-HD) as an alternative to the standard operating microscope. A customized support arm and an adaptor to firmly connect the VITOM® 3D-HD camera to the laser micromanipulator were specially designed. This setup was used as an alternative to the standard operating microscope in a cohort of 17 patients affected by suspicious early to intermediate pharyngo-laryngeal neoplasms. A historical cohort of patients treated with the traditional setting and matching the same inclusion criteria was used as a reference for the duration of surgical procedures. The surgical procedures comprised 7 cordectomies, 2 endoscopic partial supraglottic laryngectomies, 4 tongue base resections, and 4 lateral oropharyngectomies or hypopharyngectomies. In 6 cases (35%), a simultaneous neck dissection was performed. The low rate of positive deep (6%) or superficial (12%) margins reinforced the safety of this platform, and the results obtained in terms of operating time were comparable to the control group (p > 0.05), which confirms the feasibility of the system. Our surgical setting setup is a convincing alternative to traditional transoral laser microsurgery for early to intermediate pharyngo-laryngeal neoplasms. The main advantages of this system are comfortable ergonomics for the first surgeon and a potential benefit in terms of teaching if applied in university hospitals, since the entire surgical team can view the same surgical 3D-HD view of the first operator. Further work is still needed to objectively compare the traditional and new technique, and to validate our preliminary clinical findings.

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Author notes

  1. Giorgio Peretti and Leonardo S. Mattos contributed equally to this work.

Authors and Affiliations

  1. IRCCS Ospedale Policlinico San Martino, Genoa, Italy

    Andrea Luigi Camillo Carobbio, Francesco Missale, Marco Fragale, Francesco Mora, Luca Guastini, Giampiero Parrinello, Frank Rikki Mauritz Canevari & Giorgio Peretti

  2. Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy

    Andrea Luigi Camillo Carobbio, Marco Fragale, Francesco Mora, Luca Guastini, Frank Rikki Mauritz Canevari & Giorgio Peretti

  3. Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy

    Francesco Missale

  4. Biomedical Robotics Lab, Department of Advanced Robotics, Istituto Italiano di Tecnologia, Genoa, Italy

    Leonardo S. Mattos

Authors
  1. Andrea Luigi Camillo Carobbio
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  2. Francesco Missale
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  3. Marco Fragale
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  4. Francesco Mora
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  7. Frank Rikki Mauritz Canevari
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  8. Giorgio Peretti
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  9. Leonardo S. Mattos
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Correspondence to Francesco Missale.

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The authors certify that they have no affiliation with or involvement in any organization or entity with any financial interest.

Ethical approval

The research did not involve any animal models; the research involved human participants in accordance with the ethical standards of the institutional and/or national research committees and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards; and informed consent was obtained from all individual participants included in the study. Ethical review and approval was not required for this study in accordance with the national and institutional requirements (Ethics committee IRCCS Ospedale Policlinico San Martino, Genoa). However, all patients preoperatively signed a consent form for disclosure of privacy in managing personal data for scientific purposes.

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Carobbio, A.L.C., Missale, F., Fragale, M. et al. Transoral laser microsurgery: feasibility of a new exoscopic HD-3D system coupled with free beam or fiber laser. Lasers Med Sci 36, 1865–1872 (2021). https://doi.org/10.1007/s10103-020-03221-w

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  • DOI: https://doi.org/10.1007/s10103-020-03221-w

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