Transoral Robotic Surgery Using the Thulium: YAG Laser

 2012 Feb;138(2):158-66. doi: 10.1001/archoto.2011.1199.

Authors: Kathryn M. Van Abel, MD; Eric J. Moore, MD; Matthew L. Carlson, MD; Jennifer A. Davidson, PA; Joaquin J. Garcia, MD; Steven M. Olsen, MD; Kerry D. Olsen, MD

Objective: To compare thulium:YAG laser–assisted transoral robotic surgery (TY:TORS) and conventional electrocautery- equipped TORS (EC:TORS) in patients undergoing transoral resection of upper aerodigestive tract malignant neoplasms.

Design: Prospective matched cohort study.

Setting: Tertiary academic referral center.

Patients: Fifteen patients undergoing TY:TORS were matched on the basis of tumor site, clinical T stage, sex,
and age with 30 control subjects undergoing EC:TORS.

Main Outcome Measures: The primary outcome was a comparison between the feasibility of TY: TORS compared with EC:TORS. The secondary outcome was a comparison between the safety and functional outcome of TY : TORS compared
with EC:TORS in patients undergoing resection of upper aero digestive tract malignant neoplasms.

Results: All the tumors underwent complete excision with negative margins. Estimated blood loss was minimal (<150 mL) for 87% of TY:TORS patients (13 of 15) and 63% of EC:TORS controls (19 or 30). Intraoperative pharyngotomy was reported in 8% of TY:TORS patients (1 of 13) and 42% of EC:TORS controls (11 of 30) (P=.03). Postoperative pain was greater in EC:TORS compared with TY:TORS (P=.02). No statistically significant differences were noted in hemostasis, postoperative bleeding rates, or other complications.

Conclusions: Compared with EC:TORS, TY:TORS seems feasible and safe. In addition, TY:TORS resulted in fewer intraoperative pharyngotomies and less postoperative pain than did EC:TORS, which may be because of decreased collateral thermal damage, improved visualization, and finer cutting using the thulium laser.