Browsing by Author "Larson, Andrew. R."

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    Transoral Robotic Oropharyngectomy (TORS) Surgical Technique for Cancers of Tonsil and Base of Tongue
    (University of Cape Town, 2025-05-18) Meyer, Charles. D.; Larson, Andrew. R.; Richmon, Jeremy. D.; Holcomb, Andrew. J.; Fagan, Johan
    In this chapter the authors describe the use of transoral robotic surgery (TORS) for excision of tonsil and base of tongue (BOT) tumours, including patient selection, preoperative workup, operative management, and perioperative care. As of 2015, The Centers for Disease Control and Prevention (CDC) reported 18,917 new cases of oropharyngeal cancers (OPSCC) annually. This burden of disease has increased in recent decades with the rapid increase of human papillomavirus (HPV) associated squamous cell carcinoma (SCC), which is now found in 70% of new cases in the United States of America and Europe. Traditionally, surgical management of OPSCC required either transoral resection or open approaches, including suprahyoid (transhyoid) pharyngotomy, lip-split mandibulotomy (mandibular swing), or pull-through techniques that utilise a transcervical visor incision. While these approaches provide excellent surgical access, they may cause significant functional impairment.
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    Transoral Robotic Surigical (TORS) Approaches to the Parapharyngeal Space, Hypopharynx and Larynx
    (University of Cape Town, 2025-05-18) Larson, Andrew. R.; Holcomb, Andrew. J.; Richmon, Jeremy. D.; Fagan, Johan
    In this chapter the authors describe the use of transoral robotic surgery (TORS) for pathology of the parapharyngeal space (PPS), hypopharynx, and larynx. The PPS is a complex anatomical space extending from the skull base to the level of the hyoid. Most tumours are benign and are traditionally accessed through transcervical and/or transparotid approaches due to the complex anatomy in this area. With technological advances, however, transoral approaches have regained popularity for selected tumours as they allow surgeons to avoid neck scars, and generally present less risk to cranial nerves compared to transcervical and transparotid approaches. TORS, with its high-fidelity 3D visualisation, magnification, lighting, and fully wristed instrumentation, has expanded the indications and popularity of the transoral approach. Herein we describe the relevant anatomy, indications, and surgical steps of the TORS approach to the PPS.
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    Transoral Robotic Thyroidectomy (TORT) and Robotic Facelift Thyroidectomy (RFT)
    (University of Cape Town, 2025-05-18) Abt, Nicholas. B.; Larson, Andrew. R.; Holcomb, Andrew. J.; Richmond, Jeremy. D,; Fagan, Johan
    There has been an evolution of various surgical approaches to thyroidectomy since the transcervical approach was adapted over 150 years ago. Both robotic and endoscopic techniques have been developed with access to the thyroid from the axilla, lateral neck, or oral cavity resulting in a hidden or less conspicuous scar 1–3. These approaches have been developed as the adverse effect of a cervical scar on quality of life has been better understood, particularly in young women. These effects are often compounded in patients with darker skins or those prone to hypertrophic scars or keloids. Central to pursuing any remote-access or “scarless” approach, there needs to be a compromise between minimal tissue disruption with a resultant visible scar (e.g. transcervical ap-proach) and extensive tissue disruption with a remote, hidden scar (e.g. remote access approach). One should keep in mind that the primary advantage of remote access thyroid surgery is to avoid a conspicuous neck scar.