Intraoperative optical biopsy assessment during TORS head and neck cancer resections-a novel application of confocal laser endomicroscopy with intravenous fluorescein

Margin assessment during transoral robotic surgical (TORS) resections of head and neck mucosal malignancies can be complex, originating in part from discrepancies in definitions of positive or close margins, and the technical difficulty of revising microscopic margins intraoperatively without incurring the functional consequences associated with soft tissue deficits in the oropharynx and larynx. Intraoperative optical imaging modalities, including confocal laser endomicroscopy (CLE), may represent an alternative or adjunctive option to delineate tumor footprint and assess for peripheral margin status. We present a case series describing our use of the Cellvizio® probe-based CLE platform as an intraoperative modality to assess for peripheral mucosal margins in the larynx, oropharynx, and hypopharynx during TORS resections using robotic instrumentation to establish basic feasibility and create the groundwork for future investigations of relative efficacy and impact on local recurrence rates. • Confocal laser endomicroscopy (CLE) permits intraoperative mucosal disease assessment. • Probe-based CLE serves as an adjunct to standard histopathologic assessment. • Robotic CLE probe manipulation functions in the larynx, oropharynx, and hypopharynx.