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Our Experience—Design and Delivery of a Safe Trans Oral Robotic Programme in the National Health Service (NHS)

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Abstract

Trans oral robotic surgery (TORS) is a minimally invasive technique for head and neck cancers. It is shown favourable recovery and long-term functionality outcomes compared to traditional treatments. Our department at the Royal Surrey County Hospital implemented a service transformation project for a TORS programme in December 2019. The “plan, do, study and act” (PDSA) quality improvement model was used. This incorporated logistical, training, clinical and financial aspects. Twenty-five patients were selected for oropharyngectomy, tonsillectomy or tongue base resections over a period of 1 year. Patients were matched with similar patients undergoing the same non-robotic procedures. TORS showed an improvement in time required to return to normal diet and time needing regular analgesia. Peri-operative complications were similar in both groups. An improving learning curve was observed over time for console times.

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References

  1. Golusiński W, Pieńkowski P, Majchrzak E (2019) Robotic surgery (da Vinci Xi system) in head and neck cancer - own experience. Otolaryngol polska Pol Otolaryngol 74(1):1–5. https://doi.org/10.5604/01.3001.0013.5262

    Article  Google Scholar 

  2. Intuitive. Intuitive for head and neck surgeons. Available from https://www.intuitive.com/en-us/healthcare-professionals/surgeons/head-and-neck

  3. Gross ND, Holsinger FC, Magnuson JS, Duvvuri U, Genden EM, Ghanem TA, Yaremchuk KL, Goldenberg D, Miller MC, Moore EJ, Morris LG, Netterville J, Weinstein GS, Richmon J (2016) Robotics in otolaryngology and head and neck surgery: recommendations for training and credentialing: a report of the 2015 AHNS education committee, AAO-HNS robotic task force and AAO-HNS sleep disorders committee. Head Neck 38(Suppl 1):E151–E158. https://doi.org/10.1002/hed.24207

    Article  PubMed  PubMed Central  Google Scholar 

  4. Hargreaves S, Beasley M, Hurt C, Jones TM, Evans M (2019) Deintensification of adjuvant treatment after transoral surgery in patients with human papillomavirus-positive oropharyngeal cancer: the conception of the PATHOS study and its development. Front Oncol 9:936. https://doi.org/10.3389/fonc.2019.00936

    Article  PubMed  PubMed Central  Google Scholar 

  5. NHS Improvement. National tariff payment system. Available from https://improvement.nhs.uk/resources/national-tariff/#h2-tariff-documents. Accessed June 2020

  6. Moore EJ, Hinni ML (2013) Critical review: transoral laser microsurgery and robotic-assisted surgery for oropharynx cancer including human papillomavirus-related cancer. Int J Radiat Oncol Biol Phys 85(5):1163–1167. https://doi.org/10.1016/j.ijrobp.2012.08.033

    Article  PubMed  Google Scholar 

  7. Motz K, Chang HY, Quon H, Richmon J, Eisele DW, Gourin CG (2017) Association of transoral robotic surgery with short-term and long-term outcomes and costs of care in oropharyngeal cancer surgery. JAMA Otolaryngol Head Neck Surg 143(6):580–588. https://doi.org/10.1001/jamaoto.2016.4634

    Article  PubMed  PubMed Central  Google Scholar 

  8. Hardman J, Liu Z, Brady G, Roe J, Kerawala C, Riva F, Clarke P, Kim D, Bhide S, Nutting C, Harrington K, Paleri V (2020) Transoral robotic surgery for recurrent cancers of the upper aerodigestive tract-systematic review and meta-analysis. Head Neck 42(5):1089–1104. https://doi.org/10.1002/hed.26100

    Article  PubMed  Google Scholar 

  9. Stokes W, Ramadan J, Lawson G, Ferris FRL, Holsinger FC, Turner MT (2021) Bleeding complications after transoral robotic surgery: a meta-analysis and systematic review. Laryngoscope 131(1):95–105. https://doi.org/10.1002/lary.28580

    Article  PubMed  Google Scholar 

  10. Lawson, G., Matar, N., Remacle, M., Jamart, J., & Bachy, V. (2011). Transoral robotic surgery for the management of head and neck tumors: learning curve. European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology Head and Neck Surgery, 268(12), 1795–1801. https://doi.org/10.1007/s00405-011-1537-

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Correspondence to Jamie Patel.

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Patel, J., Thompson, G., Nocivin, I. et al. Our Experience—Design and Delivery of a Safe Trans Oral Robotic Programme in the National Health Service (NHS). Indian J Surg 86, 167–171 (2024). https://doi.org/10.1007/s12262-023-03850-9

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