Advertisement

European Archives of Oto-Rhino-Laryngology

, Volume 269, Issue 8, pp 1979–1984 | Cite as

Transoral robotic surgery for head and neck carcinomas

  • Stéphane HansEmail author
  • Cécile Badoual
  • Philippe Gorphe
  • Daniel Brasnu
Head and Neck

Abstract

The objective of this study was prospectively to assess the feasibility and safety of transoral robotic surgery (TORS) in head and neck carcinomas and to report our learning curve and 2-year outcomes. Patients with oropharyngeal, hypopharyngeal and laryngeal tumors treated with TORS were prospectively included. We evaluated: the feasibility of TORS, robotic set-up time, transoral robotic surgery time, blood loss, surgical margins, tracheotomy, feeding tube, time to oral feeding and surgery-related complications. Twenty-three patients were treated for 25 carcinomas. Twenty-two patients underwent successful robotic resection for 24 carcinomas (96%). One patient required conversion to open surgery due to massive bleeding. The mean robotic set-up time was 25 min (range: 15–100 min) and mean TORS operating time was 70 min (range: 20–150 min). Positive margin of resection was observed in one patient (classified pT3) out of the 24 cancers and was managed by postoperative chemoradiation. No tracheotomy was performed. Three patients required prolonged intubation for a mean of 22 h. Two patients required a temporary gastrostomy (for 2 and 3.5 months, respectively). All other patients resumed oral feeding between the first and third postoperative day. The mean hospital stay was 6.4 days (range: 4–19 days). No postoperative complication occurred. Mean follow-up was 20 months (median: 19, range: 14–26). No death and no case of local or metastatic failure were observed. TORS is feasible and safe for the resection of selected head and neck carcinomas. The occurrence of intraoperative bleeding emphasizes the need for surgeons to be skilled in both transoral and open approaches.

Keywords

Transoral robotic surgery Head and neck carcinomas Minimally invasive surgery 

Notes

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Mc Leod IK, Mair EA, Melder PC (2005) Potential applications of the Da Vinci minimally invasive surgical robotic system in otolaryngology. Ear Nose Throat J 84:483–487Google Scholar
  2. 2.
    Hockstein NG, Nolan JP, BWJr O’Malley, Woo YJ (2005) Robot-assisted pharyngeal and laryngeal microsurgery: results of robotic cadaver dissections. Laryngoscope 115:1003–1008PubMedCrossRefGoogle Scholar
  3. 3.
    Weinstein GS, O’Malley BW Jr, Hockstein NG (2006) Transoral robotic surgery: supraglottic laryngectomy in a canine model. Laryngoscope 11:1315–1319Google Scholar
  4. 4.
    O’Malley BW Jr, Weinstein GS, Hockstein NG (2006) Transoral robotic surgery (TORS): glottic microsurgery in a canine model. J Voice 20:263–268PubMedCrossRefGoogle Scholar
  5. 5.
    Weinstein GS, O’Malley BW, Snyder W (2007) Transoral robotic surgery tonsillectomy. Arch Otolaryngol Head Neck Surg 133:1220–1226PubMedCrossRefGoogle Scholar
  6. 6.
    Moore EJ, Olsern KD, Kasperbauer JL (2009) Transoral robotic surgery for oropharyngeal squamous cell carcinoma: a prospective study of feasibility and functional outcomes. Laryngoscope 119:2156–2164PubMedCrossRefGoogle Scholar
  7. 7.
    Genden EM, Desai S, Sung CK (2009) Transoral robotic surgery for the management of head and neck cancer: a preliminary experience. Head Neck 31:283–289PubMedCrossRefGoogle Scholar
  8. 8.
    Boudreaux BA, Rosenthal EI, Magnuson JS, Newman JR, Desmond RA, Clemons L, Carroll WR (2009) Robot-assisted surgery for upper aerodigestive tract neoplasms. Arch Otolaryngol Head Neck Surg 135:397–401PubMedCrossRefGoogle Scholar
  9. 9.
    Weinstein GS, Quon H, O’Malley BW Jr, Kim GG, Cohen MA (2010) Selective neck dissection and deintensified postoperative radiation and chemotherapy for oropharyngeal cancer: a subset analysis of the University of Pennsylvania transoral robotic surgery trial. Laryngoscope 120:1749–1755PubMedCrossRefGoogle Scholar
  10. 10.
    White HN, Moore EJ, Rosenthal EL et al (2010) Transoral robotic-assisted surgery for head and neck squamous cell carcinoma: one- and 2-year survival analysis. Arch Otolaryngol Head Neck Surg 136:1248–1252PubMedCrossRefGoogle Scholar
  11. 11.
    Weinstein GS, O’Malley BW Jr, Cohen MA, Quon H (2010) Transoral robotic surgery for advanced oropharyngeal carcinoma. Arch Otolaryngol Head Neck Surg 136:1079–1085CrossRefGoogle Scholar
  12. 12.
    Genden EM, Park R, Smith C, Kotz T (2011) The role of reconstruction for transoral robotic pharyngectomy and concomitant neck dissection. Arch Otolaryngol Head Neck Surg 137:151–156PubMedCrossRefGoogle Scholar
  13. 13.
    Hurtuk A, Agrawal A, Old M, Teknos TN, Ozer E (2011) Outcomes of transoral robotic surgery: a preliminary clinical experience. Otolaryngol Head Neck Surg 145:248–253PubMedCrossRefGoogle Scholar
  14. 14.
    Iseli TA, Kulbersh BD, Iseli CE, Carroll WR, Rosenthal EL, Magnuson JS (2009) Functional outcomes after transoral robotic surgery for head and neck cancer. Otolaryngol Head Neck Surg 141:166–171PubMedCrossRefGoogle Scholar
  15. 15.
    Lawson G, Matar N, Remacle M, Jamart J, Bachy V (2011) Transoral robotic surgery for the management of head and neck tumors: learning curve. Eur Arch Otorhinolaryngol [Epub ahead of print]Google Scholar
  16. 16.
    Sobin LH, Wittekind C (2002) UICC International Union Against Cancer. TNM classification of malignant tumors, 6th ed. Wiley, New York, pp 36–42Google Scholar
  17. 17.
    Remacle M, Eckel HE, Antonelli A et al (2000) Endoscopic cordectomy. A proposal for a classification by the Working Committee European Laryngological Society. Eur Arch Otorhinolaryngol 257:227–231PubMedCrossRefGoogle Scholar
  18. 18.
    Byers RM (1994) Anatomic correlates in head and neck surgery. The lateral pharyngotomy. Head Neck 16:460–462PubMedCrossRefGoogle Scholar
  19. 19.
    Solares CA, Strome M (2007) Transoral robot-assisted CO2 laser supraglottic laryngectomy: experimental and clinical data. Laryngoscope 117:817–820PubMedCrossRefGoogle Scholar
  20. 20.
    Desai SC, Sung CK, Jang DW, Genden EM (2008) Transoral robotic surgery using a carbon dioxide flexible laser for tumors of the upper aerodigestive tract. Laryngoscope 118:2187–2189PubMedCrossRefGoogle Scholar
  21. 21.
    Fried MP, Sadoughi B, Gibber MJ et al (2010) From virtual reality to the operating room: the endoscopic sinus surgery simulator experiment. Otolaryngol Head Neck Surg 142:202–207PubMedCrossRefGoogle Scholar
  22. 22.
    Park YM, Kim WS, Byeon HK, De Virgilio A, Jung JS, Kim SH (2010) Feasibility of transoral robotic hypopharyngectomy for early-stage hypopharyngeal carcinoma. Oral Oncol 46:597–602PubMedCrossRefGoogle Scholar
  23. 23.
    Flores TC, Wood BG, Levine HL, Koegel L Jr, Tucker HM (1982) Factors in successful deglutition following supraglottic laryngeal surgery. Ann Otol Rhinol Laryngol 91:579–583PubMedGoogle Scholar
  24. 24.
    Lee HK, Goepfert H, Wendt CD (1990) Supraglottic laryngectomy for intermediate-stage cancer. UT MD Anderson Cancer Center experience with combined therapy. Laryngoscope 100:831–836PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Stéphane Hans
    • 1
    • 2
    Email author
  • Cécile Badoual
    • 2
    • 3
  • Philippe Gorphe
    • 1
    • 2
  • Daniel Brasnu
    • 1
    • 2
  1. 1.Department of Otolaryngology—Head and Neck SurgeryHôpital Européen Georges PompidouParisFrance
  2. 2.Assistance Publique—Hôpitaux de Paris, Faculté de médecineUniversité Paris DescartesSorbonne ParisFrance
  3. 3.Department of PathologyHôpital Européen Georges PompidouParisFrance

Personalised recommendations