Transoral robotic surgery in a modified Trendelenburg position for oropharyngeal squamous cell carcinoma in a patient with severe thoracic kyphosis

Head Neck. 2023 Mar;45(3):E5-E9. doi: 10.1002/hed.27271. Epub 2022 Dec 22.

Abstract

Background: Excessive flexion of the neck and upper back from severe kyphosis of the thoracic spine may limit treatment options for head and neck cancer (HNC).

Methods: We describe an innovative approach to transoral robotic surgery (TORS) in a patient with severe thoracic kyphosis and oropharyngeal squamous cell carcinoma (OPSCC) who was unsuitable for definitive radiotherapy.

Results: Detailed discussion of management pathway, perioperative considerations, and surgical challenges is presented. TORS lateral oropharyngectomy was successfully performed with the robotic system docked from the caudal end in a modified Trendelenburg position.

Conclusions: With appropriate surgical and anesthetic planning, TORS for patients with severe thoracic kyphosis is a feasible and suitable treatment.

Keywords: anesthesia; ankylosing spondylitis; kyphosis; oropharyngeal cancer; robotic surgery.

Publication types

  • Case Reports

MeSH terms

  • Carcinoma, Squamous Cell* / complications
  • Carcinoma, Squamous Cell* / pathology
  • Carcinoma, Squamous Cell* / surgery
  • Head and Neck Neoplasms* / complications
  • Head and Neck Neoplasms* / surgery
  • Head-Down Tilt
  • Humans
  • Kyphosis* / etiology
  • Kyphosis* / surgery
  • Oropharyngeal Neoplasms* / complications
  • Oropharyngeal Neoplasms* / pathology
  • Oropharyngeal Neoplasms* / surgery
  • Robotic Surgical Procedures*
  • Squamous Cell Carcinoma of Head and Neck / surgery