OBJECTIVE: To assess the initial experience for transoral robotic surgery (TORS), as observed in the French TORS group. STUDY DESIGN: A multi-institutional prospective cohort study. SETTING: Seven tertiary referral centers. SUBJECTS AND METHODS: One hundred thirty consecutive patients who were scheduled for a TORS between October 2008 and March 2011 were included. The operative times, conversion rates, morbidity, and alternatives were described. The serious adverse effects encountered were analyzed, and recommendations for avoiding them are specified. RESULTS: Most of the patients (65%) had a laryngeal (supraglottic) and/or hypopharyngeal resection. Thirty-nine of the 130 patients receiving TORS would have had a transoral laser resection as their alternative surgery. The tumor exposure was suboptimal in 26% of the cases. Six of the 130 patients needed conversion to an open approach. There were 15 postoperative hemorrhages and 2 deaths due to posthemorrhage complications in patients with significant comorbidities at 9 and 18 days after the surgery. The median setup and procedure times were 52 ± 46 and 90 ± 92 minutes, respectively. The learning curve was characterized by better selection and management of potential patients. CONCLUSION: The visualization offered by the robotic assistance allowed transoral resections of tumors that were difficult to resect or unresectable by laser surgery. Self-assessment of surgical exposure and a decrease in the need to convert to an open procedure over time suggested improvement in TORS-related surgical skills. Nevertheless, strict patient selection is essential. Even with a minimally invasive approach, some patients will need a tracheostomy for safety reasons.
OBJECTIVE: To assess the initial experience for transoral robotic surgery (TORS), as observed in the French TORS group. STUDY DESIGN: A multi-institutional prospective cohort study. SETTING: Seven tertiary referral centers. SUBJECTS AND METHODS: One hundred thirty consecutive patients who were scheduled for a TORS between October 2008 and March 2011 were included. The operative times, conversion rates, morbidity, and alternatives were described. The serious adverse effects encountered were analyzed, and recommendations for avoiding them are specified. RESULTS: Most of the patients (65%) had a laryngeal (supraglottic) and/or hypopharyngeal resection. Thirty-nine of the 130 patients receiving TORS would have had a transoral laser resection as their alternative surgery. The tumor exposure was suboptimal in 26% of the cases. Six of the 130 patients needed conversion to an open approach. There were 15 postoperative hemorrhages and 2 deaths due to posthemorrhage complications in patients with significant comorbidities at 9 and 18 days after the surgery. The median setup and procedure times were 52 ± 46 and 90 ± 92 minutes, respectively. The learning curve was characterized by better selection and management of potential patients. CONCLUSION: The visualization offered by the robotic assistance allowed transoral resections of tumors that were difficult to resect or unresectable by laser surgery. Self-assessment of surgical exposure and a decrease in the need to convert to an open procedure over time suggested improvement in TORS-related surgical skills. Nevertheless, strict patient selection is essential. Even with a minimally invasive approach, some patients will need a tracheostomy for safety reasons.
Authors: Joseph Zenga; Jasmina Suko; Dorina Kallogjeri; Patrik Pipkorn; Brian Nussenbaum; Ryan S Jackson Journal: Laryngoscope Date: 2017-04-20 Impact factor: 3.325
Authors: Philippe Gorphe; Jean Von Tan; Sophie El Bedoui; Dana M Hartl; Anne Auperin; Quentin Qassemyar; Antoine Moya-Plana; François Janot; Morbize Julieron; Stephane Temam Journal: J Robot Surg Date: 2017-01-07
Authors: B Lallemant; S Moriniere; P Ceruse; M Lebalch; K Aubry; S Hans; G Dolivet; O Malard; Q Bonduelle; S Vergez Journal: Eur Arch Otorhinolaryngol Date: 2017-10-14 Impact factor: 2.503
Authors: John R de Almeida; Ryan Li; J Scott Magnuson; Richard V Smith; Eric Moore; Georges Lawson; Marc Remacle; Ian Ganly; Dennis H Kraus; Marita S Teng; Brett A Miles; Hilliary White; Umamaheswar Duvvuri; Robert L Ferris; Vikas Mehta; Krista Kiyosaki; Edward J Damrose; Steven J Wang; Michael E Kupferman; Yoon Woo Koh; Eric M Genden; F Christopher Holsinger Journal: JAMA Otolaryngol Head Neck Surg Date: 2015-12 Impact factor: 6.223