Early Adoption of Transoral Robotic Surgical Program

Cognetti, David M.; Luginbuhl, Adam; Nguyen, Anthony; Curry, Joseph M.

doi:10.1177/0194599812443353

Cited by 25 publications

(20 citation statements)

References 32 publications

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“…7, 8). Use of this technique provided for a rate of exposure adequacy, exposure time, operative time, completeness of resection, and functional outcomes that fall well within the range of those published by experienced centers using a variety of different mouth gags [2][3][4][5][6][7][8]. Indeed, the exposure time is actually somewhat lower than those previously reported.…”

Section: Discussionsupporting

confidence: 56%

Tongue base exposure during TORS without the use of a mouth prop

Miller

2016

J Robotic Surg

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This study describes a novel exposure technique for base of tongue trans-oral robotic surgery (BOT TORS) and early experience with it. The technique discussed involves placement of a suture through the mobile tongue with distraction and suspension of the tongue to the operating table. TORS is then performed per previously described techniques. In our series, 13 patients with either benign or malignant mass lesions involving the tongue base were treated with TORS at a tertiary academic medical center. We reviewed the rates of adequate exposure, console time, adequacy of resection (in malignant cases), complication rates, and costs associated with this technique. In our series, adequate exposure was achieved in 92.3 % of patients. Mean console time was 36 min. Negative surgical margins were achieved in all cancer resections. Five minor complications (tongue lacerations) were observed. Per-case cost attributable to this technique is $3.81. We conclude that BOT TORS is feasible without the use of a mouth prop. Operative times are consistent with those reported by centers that routinely use mouth props for BOT TORS. This technique does not appear to compromise margin adequacy during oncologic resections. Its use may result in a significant cost savings when compared to the FK and other similar retractors.

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Section: Discussionsupporting

confidence: 56%

Tongue base exposure during TORS without the use of a mouth prop

Miller

2016

J Robotic Surg

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“…27,30,42,61,62,72–74 Swallowing-related QOL is reported to decrease immediately following TORS, but has been demonstrated to improve by 1 year post treatment, with possible further improvement thereafter 79. In the study of Cognetti et al,58 most patients resumed oral intake by postoperative day 1, with 91% of patients tolerating oral intake at the first postoperative visit. In the 12 patients who were taking an oral diet with tube feed supplementation, the PEG tube had been placed for anticipated adjuvant therapy with chemoradiation based on clinical staging.…”

Section: Functional Outcomes (Table 4)mentioning

confidence: 99%

Transoral Robotic Surgery in the HPV Era

Duek¹,

Billan²,

Amit³

et al. 2014

Rambam Maimonides Med J

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The incidence of oropharyngeal squamous cell carcinoma (OPSCC) has markedly increased over the last three decades mostly due to human papillomavirus (HPV)-related infections. Cancers resulting from HPV infection bear a better prognosis than those that are smoking-related. Because HPV-positive patients are often younger, with lower rates of co-morbid illness and longer overall life expectancies, long-term sequelae of therapy have become an important issue. Treatment of oropharyngeal cancers has typically involved the use of radiation and chemotherapy to avoid the morbidity of open surgery which included mandibulotomy and composite resection. Transoral robotic surgery (TORS) is an emerging treatment option for this disease, avoiding the morbidity of open approaches while providing excellent oncologic and functional outcomes. With overall survival rate at 2 years exceeding 80%, and local failure rate of less than 3%, patients receiving TORS report relatively good health-related quality of life (QOL) scores. The aim of the current review is to provide a summary of the current literature with regard to the oncologic and functional outcomes following treatment of OPSCC with TORS.

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“…Later, O’Malley and colleagues 14 reported the technical feasibility of robot-assisted surgery for base of tongue (BOT) neoplasm resection; Weinstein and colleagues 15 successfully performed a robot-assisted radical tonsillectomy in 2007 after cadaveric robotic surgery. With this much groundwork completed, several studies subsequently focused on the application of TORS in various types of neoplasms, including squamous cell carcinoma, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59 mucoepidermoid carcinoma, 16, 35, 43, 50, 60, 61 malignant melanoma, 62 synoviosarcoma, 33, 63 adenoid cystic carcinoma, 33, 35, 43, 50, 60, 64 pleomorphic adenoma, 32, 35, 47, 65 lipoma 33 and neurilemmoma. 64 …”

Section: Clinical Applications Of Robotic Surgery In the Head And Neckmentioning

confidence: 99%

“…Several subsequent reports showed favorable results, such as short hospital stays, quick functional recovery and a lack of significant complications, when parapharyngeal neoplasms (squamous cell carcinoma, lipoma, pleomorphic adenoma, adenoid cystic carcinoma, cartilaginous tumor and neurilemmoma) were removed using the robot. 36, 61, 73, 74, 75 Chan et al 76 reported that 24% of patients with pleomorphic adenoma experienced unexpected capsule breakage or neoplasm fracture during surgery, potentially resulting from an inability to safely grasp the tumor, sharp instruments and a lack of tactile and haptic feedback.…”

Section: Clinical Applications Of Robotic Surgery In the Head And Neckmentioning

confidence: 99%

Robotic surgical systems in maxillofacial surgery: a review

Liu

Shi

et al. 2017

Int J Oral Sci

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Throughout the twenty-first century, robotic surgery has been used in multiple oral surgical procedures for the treatment of head and neck tumors and non-malignant diseases. With the assistance of robotic surgical systems, maxillofacial surgery is performed with less blood loss, fewer complications, shorter hospitalization and better cosmetic results than standard open surgery. However, the application of robotic surgery techniques to the treatment of head and neck diseases remains in an experimental stage, and the long-lasting effects on surgical morbidity, oncologic control and quality of life are yet to be established. More well-designed studies are needed before this approach can be recommended as a standard treatment paradigm. Nonetheless, robotic surgical systems will inevitably be extended to maxillofacial surgery. This article reviews the current clinical applications of robotic surgery in the head and neck region and highlights the benefits and limitations of current robotic surgical systems.

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Early Adoption of Transoral Robotic Surgical Program

Abstract: The initiation of a TORS program in the post-FDA setting can be achieved in a safe and efficient manner. Early results of pioneering TORS centers are reproducible. Continued investigation of TORS as a treatment option for oropharyngeal carcinoma is warranted.

Cited by 25 publications

References 32 publications

Tongue base exposure during TORS without the use of a mouth prop

Tongue base exposure during TORS without the use of a mouth prop

Transoral Robotic Surgery in the HPV Era

Robotic surgical systems in maxillofacial surgery: a review

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