THE TECHNIQUE

TOUSS or TransOral Ultrasonic Surgery is a procedure designed for a minimally invasive approach to upper aerodigestive lesion treatment.

Based on the laparoscopic method and the philosophy of tackling the pathology from the least invasive way of access for the patient, TOUSS allows the treatment of pharynx and larynx cancer, along with other benign lesions of the head and neck through the mouth and avoiding external access.

The high-quality image of the endoscope allows for a neat and precise vision of the field. This, combined with the technology of cut and coagulation of the Thunderbeat, results in a safe, almost bloodless resection of the tumour.

THE TOUSS PHILOSOPHY

TOUSS was designed in order to offer a minimally invasive surgery approach from the very beginning. It is based in the use of the endoscopic tool in a transoral fashion (that is, through the mouth) targeted to the head and neck pathology, both malign and benign. This way the patient will avoid the big physical consequences that are the usual aftermath of a classic open surgery. Up until the appearance of this technique, a transoral endoscopic surgery was only possible to do with a robotic platform, inaccessible to the vast majority of medical institutions worldwide.

TOUSS has become a surgical alternative to the robotic surgery, in the same cases the latter is applied. This is done with materials and technology accessible to most hospitals. The TOUSS philosophy consists on placing a bet in the development of minimally invasive surgery without the costs of a robot. This way this procedure is universalized for patients from different income backgrounds, making it more egalitarian.

The two key words that describe this project are: minimally invasive surgery and accessibility. Those are the concepts we like to promote: making it as universal as possible due to accessibility and offering a modern, high-quality, minimally invasive surgery.

BENEFITS OF TOUSS

A less invasive and detrimental surgery

TOUSS sets a main difference against traditional surgery in that it is a minimally invasive procedure, designed to inflict the least amount of damage possible to healthy tissue. Inspired by the concept brought by the laparoscopy of single access, TOUSS uses the mouth as a natural entryway to structures like the pharynx and larynx. Aided with the image accuracy of the videoendoscopes and ultrasonic technology, it will be possible to reach, correctly visualize and operate on anatomical regions available only under the reach of open jaw surgery before.

A fast and safe procedure

As the mouth is the natural access used in this technique, it is a shorter surgical procedure, for the extensive clinical approach to the area is no longer needed. Once reached the anatomical region, the resection is quick and bloodless thanks to the ultrasound asset. With its cut and coagulation function, its efficacy isn’t comparable to the laser technique. This gains importance when the lesion is found at the base of the tongue, a highly vascularized area where bleeding happens quite easily and frequently. Moreover, the videoendoscopic technology of the EndoEYE, providing an articulated tip with a reach of 100º, will allow a direct, high-quality visualization of the region. This is crucial to gain control over the vessels and tumour edges.

A reduction of bleeding

TOUSS allows for an almost bloodless surgery thanks to the Thunderbeat, an ultrasound forceps that safely coagulates blood vessels up to 7mm wide.

An intuitive and easily acquired technique

Professionals learning the TOUSS technique show early and fast improvement. The training in endoscopic surgery through the years makes it a manageable and intuitive technique.

A limitless and expandable idea

TOUSS offers the possibility of expansion inside the minimally invasive surgery of pharynx and larynx, which was tied to the robotic method up until recently. It allows the surgeon to reach anatomical regions only available by open surgery before, which conforms a great capital to exploit. The possibilities are vast: from its initial purpose of lesion removal, to the total laryngectomy, or its successful base of the tongue resection and reduction in sleep apnea (condition suffered by millions of people), this technique is versatile and can be easily reinvented. It opens up a very promising path of surgical investigation.

Economically more accessible equipment

One of the biggest advantages this new technique has to offer is the economic accessibility of the equipment used. The surgical robot, not only is very expensive to procure, but also needs thousands invested in its maintenance. This makes it non-accessible for many institutions. TOUSS is a simplified strategy based on a counter-current philosophy by using the endoscope in the head and neck surgery. It is accessible to any patient and medical institution. Not only does it mimic the results of robotic surgery, but also improves it in terms of mobility and aesthetic after the recovery.

A faster recovery

Experiencing a disease and surgical procedure can be difficult and distressing on the patient, especially if it is cancer. TOUSS provides to those in need of surgery to tackle disease, a solution that is far quicker and less traumatic than the classic procedures.

Reduced hospital stays

Because the surgery is minimally invasive, the patient won’t have to heal from major incisions, thus allowing a faster, less painful recovery. This will all mean shorter post-operational stays in the hospital.

Less post-operational issues

The issues that can come up when healthy tissue is damaged in order to access to certain anatomical regions is significantly reduced with a TOUSS approach. When a tracheotomy is needed, this is even more important, which can be discarded in many occasions, or even with the swallowing. Patients intervened with TOUSS have a less extensive cicatrization area, which enables the patient to preserve more nervous sensitivity and motor skills, the patient will start eating normally faster. These advantages are extremely important for patients that have gone through radiotherapy and quimotherapy treatments.

WHICH PATIENTS CAN BENEFIT FROM TOUSS?

TOUSS was originally designed towards the treatment of patients in the field of oncology. A majority of pharynx and larynx lesion will easily be candidates for a transoral resection through a TOUSS approach. Nevertheless, it will be the patients suffering from malign pathology, and especially when the resection is on the bigger side, the ones that will benefit the most from this technique.

TOUSS can also be considered an alternative to the snoring surgery or the reduction of some benign lesions, because it is a quick, safe and minimally invasive option.

TOUSS TEAM

Mario Fernández FernándezLourdes Montes-Jovellar GonzálezMarc Tobed SecallPablo Parente AriasFrancesc Xavier Avilés-JuradoLuis Omar Domínguez PalomeraNicoletta Gardenal

Mario Fernández Fernández

Medicine and Surgery graduate by the Santiago de Compostela University.

PhD in Medicine by the A Coruña University. He completed his residency in the specialty of Otolaryngology in the Juan Canalejo Hospital, A Coruña, and has an outstanding doctorate award from the A Coruña University.

Currently he is Head of the Head and Neck Surgery department in the Gregorio Marañón Hospital in Madrid, Secretary General of the SEORL-CCC and a member of the Otolaryngology Technical Committee of the Health Ministry of the Community of Madrid.

Also advisor in Olympus, where he leads several investigation projects.

Currently his main focus is the development of the Minimally Invasive Surgery to tackle Head and Neck cancer.

He is the forefather of the Transoral Ultrasound Endoscopic Surgery (TOUSS). He has also been the promoter of the thyroid and parathyroid video-assisted minimally invasive surgery in Spain. Furthermore, he contributes to the development of the exploration of the upper aerodigestive tract through the Narrow Band Imaging (NBI) technology at a European level. He has also directed many courses to give exposure to the TOUSS technique, thus implementing it in the national and international spheres.

Lourdes Montes-Jovellar González

Licenciada en Medicina y Cirugía por la Universidad de Navarra realiza la especialidad de Otorrinolaringología y la Tesis doctoral en la Clínica Universidad de Navarra y es premio a la mejor tesis doctoral del 2011 otorgado por la SEORL.

Es Master en métodos cuantitativos en investigación y epidemiología por la Universidad Autónoma de Madrid.

Actualmente es adjunta en la sección de Oncología de Cabeza y Cuello en el Hospital Universitario Ramón y Cajal.

Centrada en la cirugía oncológica de cabeza y cuello y en el desarrollo de la cirugía mínimamente invasiva, en especial en colaboración con el impulso y expansión de TOUSS a nivel nacional e internacional mediante cursos de formación, publicaciones en revistas internacionales y mediante su implementación en numerosos hospitales.

Marc Tobed Secall

Licenciado en Medicina y Cirugía por la Universidad Autónoma de Barcelona realiza la especialidad de Otorrinolaringología en Hospital Josep Trueta de Girona.

Actualmente es médico adjunto en el Hospital Josep Trueta de Girona y es profesor asociado de la Universidad de Girona.

Centrado en la cirugía oncológica de cabeza y cuello y en la rehabilitación de los pacientes laringectomizados, actualmente con gran implicación en el desarrollo de la cirugía mínimamente invasiva, en concreto mediante el impulso y divulgación de TOUSS, colaborando como profesor en cursos de formación, publicaciones en revistas internacionales y symposium en numerosos congresos.

Pablo Parente Arias

Licenciado en Medicina y Cirugía en la Universidad de Navarra y Doctor en Medicina por la Universidad de A Coruña, realiza su residencia en Otorrinolaringología en el Complejo Hospitalario Universitario Juan Canalejo de A Coruña, donde lidera actualmente la comisión oncológica del Centro.

Tras estancias formativas en Estados Unidos (Memorial Sloan Kettering Cancer Center y MD Anderson Cancer Center), se especializa en Cirugía de Cabeza y Cuello, centrando sus esfuerzos en cirugía mínimamente invasiva videoasistida de cuello (tiroides, paratirodes y submaxilar) y en cirugía oncológica, tanto transoral endoscópica y TOUSS como reconstructiva con colgajos libres.

Francesc Xavier Avilés-Jurado MD, PhD

Licenciado en medicina por la Universitat Autònoma de Barcelona, realiza la especialidad de Otorrinolaringología en el Hospital Universitari Joan XXIII de Tarragona. Actualmente médico adjunto en la sección de Oncología de Cabeza y cuello, Servicio ORL del Hospital Clínic de Barcelona y Profesor asociado de la Universitat de Barcelona.

Postgrado en Cirugía reconstructiva por la European Microsurgery School, título de especialista en microsutura vascular y nerviosa, postgrado en Estadístioca en ciencias de la salud por la UAB y actualmente coordinador del grupo de tumores sólidos del Insitut Pere Virgili (IISPV).

Centrado en la cirugía oncológica de cabeza y cuello, así como en la investigación básica de estos tumores, actualmente colaborador en el desarrollo de TOUSS como profesor en cursos de formación, publicaciones en revistas internacionales y comunicaciones en diversos congresos nacionales e internacionales.

Luis Omar Domínguez Palomera

Licenciado en Medicina y Cirugía por la Universidad de Guadalajara, Méjico. Realiza la especialidad en Otorrinolaringología y Cirugía de Cabeza y Cuello en el Hospital Civil de Guadalajara Fray Antonio Alcalde.

Realiza la subespecialidad en Cirugía Oncológica de Cabeza y Cuello en el Instituto Jalisciense de Cancerología.

Actualmente es Adjunto en el servicio de Otorrinolaringología en la sección de Cirugía de Cabeza y Cuello en el Hospital Civil de Guadalajara Fray Antonio Alcalde.

Implicado en la expansión de TOUSS realizando los primeros casos de Méjico y el continente americano, tras acudir a los cursos de formación en TOUSS en 2017.

Nicoletta Gardenal

Licenciada en Medicina y Cirugía por la Università degli Studi di Trieste en Italia, realizando el quinto año de la especialidad en la escuela de especialización en Otorrinolaringología en la Università degli studi di Trieste, y ha realizado actividades de investigación en Oncología Centro sociale oncologico de Trieste, Italia.

Actualmente es residente rotante en el Hospital Universitario Gregorio Marañón donde desempeña la labor de colaboración en el desarrollo, estudio e investigación en TOUSS. Es profesora de apoyo en los cursos nacionales e internacionales de TOUSS impartidos en 2017.

WHERE IS TOUSS BEING PRACTICED?

WORLDWIDESPAIN

TOUSS WORLDWIDE

TOUSS IN SPAIN

 

TOUSS PROJECT POR EL MUNDO

TOUSS constituye una manera de operar más sencilla y más económica que otras técnicas. En el desarrollo y expansión de la técnica viene implícita la idea de que pueda realizarse en la mayor parte de los hospitales que tratan el cáncer de cabeza y cuello. En TOUSS PROJECT por el mundo mostraremos nuestras aventuras allá donde nos inviten a colaborar, con toda la ilusión, respeto y admiración por nuestros compañeros.

CONTACT

If you have any questions or you wish to request an appointment, do not hesitate to contact

COURSES FOR PROFESSIONALS

Yearly, several TOUSS courses are taught in different levels of expertise. Courses going from the profound knowledge of the anatomical area from a transoral and endoscopic access, to the mastering of the skills that keep being incorporated to an ever-evolving technique. These courses are a means to share ideas, discussing different concepts and create transcending working bonds.

APPLICATIONS