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Practising transoral robotic surgery in a middle-income country: surgical outcomes and early challenges

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Abstract

Transoral robotic surgery is a minimally invasive surgical technique that recently debuted in Malaysia. However, there are concerns over its cost, practicality, and feasibility in local settings. Our study aims to evaluate the surgical outcomes of transoral robotic surgery and discuss its learning curves. The clinical records of all patients who underwent transoral robotic surgery in a university hospital were reviewed. 25 patients were identified with a mean age of 43.9 years. The commonest indication was obstructive sleep apnoea (OSA) (76%), followed by base of tongue carcinoma (16%), recurrent tonsilitis and Wharton's duct cyst (4% each). For excision of tongue base in obstructive sleep apnoea without epiglottectomy, the mean operating time was 2.3(±0.9) hours with an average of 2.8(±0.4) days of hospital stay. The success rate for OSA surgery was seen in 78.9% of cases. The mean operating time for transoral excision of tongue base carcinoma was 4.3(±2.5) hours, whereas the mean hospital stay was 9(±3.6) days. All surgical margins were cleared with no recurrence except for one patient. The recurrent tumour was successfully excised via transoral robotic surgery, and he remained disease free after one year. The most frequent post-operative complaints were dysphagia, post-nasal drip, and hypogeusia. Transoral robotic surgery in Malaysia is in the commencement phase, where some pitfalls are expected. Opportunities should be given for more surgeons to acquire this technique so that minimally invasive surgery for head and neck diseases is readily available for patients in middle-income countries.

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia

    Khairil Afif Mahmud & Mohd Razif Mohamad Yunus

  2. Faculty of Medicine, Sungai Buloh Campus, UiTM Selangor Branch, Sungai Buloh, Selangor, Malaysia

    Fatin Nurul Fariha Ghazali, Muhammad Nur Islam Zahari & Haizlene Abd Halim

  3. Department of Otorhinolaryngology-Head and Neck Surgery, UiTM Private Specialist Centre, Jalan Hospital, 47000, Sg. Buloh, Selangor Darul Ehsan, Malaysia

    Ahmad Kusyairi Khalid

  4. Department of Otolaryngology and Head, Singhealth Duke-NUS Sleep Centre, Singapore, Singapore

    Song Tar Toh

Authors
  1. Khairil Afif Mahmud
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  2. Fatin Nurul Fariha Ghazali
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  3. Muhammad Nur Islam Zahari
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  4. Haizlene Abd Halim
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  5. Ahmad Kusyairi Khalid
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  6. Song Tar Toh
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  7. Mohd Razif Mohamad Yunus
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Contributions

All authors contributed to the study conception and design. Data collections were performed by Ahmad Kusyairi Khalid and research assistants. The data analysis and the first draft of the manuscript were written by Khairil Afif Mahmud. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Ahmad Kusyairi Khalid.

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The authors have no relevant financial or non-financial interests to disclose.

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This is a retrospective study and approval was obtained from relevant authorities.

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Mahmud, K.A., Ghazali, F.N.F., Zahari, M.N.I. et al. Practising transoral robotic surgery in a middle-income country: surgical outcomes and early challenges. J Robotic Surg 17, 613–618 (2023). https://doi.org/10.1007/s11701-022-01456-z

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  • DOI: https://doi.org/10.1007/s11701-022-01456-z

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