It is the surgeon’s obligation to introduce the patient to the different surgical options and consult him on the most appropriate one. With increasing experience and continued improvement in the robotic technology,

the indications for RT will continue to evolve.6 The use of the robot for neck dissection via a transaxillary incision will continue to evolve and the indications to Inhibitors,research,lifescience,medical perform RATS will continue to expand. RATS should probably be STA-4783 performed in high-volume centers, by skilled surgeons. As with any new emerging technique, careful patient selection is crucial, and further evidence must be sought to confirm its indications over time. Abbreviations: RATS robot-assisted transaxillary thyroid surgery RLN

recurrent laryngeal nerve RT robot-assisted thyroidectomy.
Laryngeal biopsies have traditionally Inhibitors,research,lifescience,medical been done in the operating room under general anesthesia in order to allow access for the cup biopsy into the larynx. Recent advances in technology such as the flexible fiberoptic and the distal chip scope allow these procedures to be performed in awake, unsedated patients. Transnasal fiberoptic laryngoscopy (TFL) has been used Inhibitors,research,lifescience,medical to direct various laryngeal procedures, such as the injection of botulinum toxin for the treatment of spasmodic dysphonia,1 vocal fold augmentation,2 laser manipulations for the treatment of laryngeal dysplasia and papillomatosis,3–7 removal of benign vocal cord lesions, and laryngeal biopsy.8,9 Until ~15 years ago, the primary means for awake laryngopharyngeal biopsy was transoral passage of long curved Inhibitors,research,lifescience,medical biopsy forceps with indirect mirror laryngoscopy guidance. With the introduction of the flexible channeled endoscopes and the flexible endoscopes with a channeled sheath, the procedure has become considerably better-tolerated by patients as well as easier to perform. Theoretically these procedures can replace direct laryngoscopy under general anesthesia for the purpose of obtaining tissue for histology. Publications on in-office laryngeal biopsy have concurred

Inhibitors,research,lifescience,medical that this procedure is safe, feasible, cost-effective, Fossariinae and easy to perform.8–11 However, only two studies look at the accuracy of in-office biopsy via TFL in patients with strongly suspected laryngopharyngeal cancer. The study from the Boston University Medical Center was a retrospective review on 11 patients that underwent in-office cup forceps biopsies between the years 2006 and 2008. The biopsies taken were only 64% diagnostic.12 Our group ran a prospective cohort study on 102 patients and found a 66% agreement between the office-based and the operating room biopsy results. The sensitivity of TFL biopsy compared with that of direct laryngoscopy biopsy was 69.2%, and the specificity was 96.1%.13 This study is a continuation of our previous study with a larger group of patients.