Intraoperative Ultrasonography during Transoral Robotic Surgery

Objective: This study describes the potential application of intraoperative ultrasound imaging during transoral robotic surgery (TORS). Methods: Ultrasound imaging was performed during transoral robotic resection of oropharyngeal tumors in 10 patients at a tertiary academic center. Ultrasound imaging was utilized to identify large-caliber vessels adjacent to the surgical site. Measurements were also taken on the ultrasound of tumor thickness to determine the deep margin. Following resection, the tumor was sectioned, and a gross measurement of the tumor thickness was obtained. Results: Intraoperative ultrasound use led to the identification of larger-caliber blood vessels within the operative field prior to encountering them visually. Ultrasound could also aid in defining deep tumor margins; the tumor thickness measured via ultrasound was found to be accurate within 1 to 2 mm of the grossly measured tumor thickness. This allowed for focused, careful dissection to protect and avoid blood vessels during dissection as well as improved tumor resection. Conclusions: The use of intraoperative ultrasound provides additional information to the head and neck surgeon during TORS. This may be used to identify blood vessels and assess tumor margins, thereby improving the safety and efficacy of TORS.