Flexible transoral robotic surgery: the Italian experience

Abstract

SUMMARY Objective This prospective, non-randomised study documents our initial experience using the Flex ® Surgical System for transoral surgery in Italy. Methods All patients who underwent transoral robotic surgery using the Medrobotics ® Flex ® Robotic System (Raynham, MA, USA) between March 2018 and April 2019 were reviewed. Rates of successful surgery, surgical time and complications were evaluated. 43 surgical procedures were performed in the study. The average age was 62.56 years (range 36-90 years). The Flex ® system was used successfully in surgery of the base of the tongue, palatine tonsils, supraglottis, hypopharynx and glottis, which was the most frequent target. Results All procedures were successfully completed. There were no intraoperative or serious postoperative complications, with no cases of intraoperative haemorrhage. Conclusions This is the first study in Italy evaluating the use of the Flex ® system to safely resect lesions in the oral cavity, larynx and pharynx.

The Flex Robotic System in Head and Neck Surgery: A Review

“…After abstract screening for eligibility, 61 articles were considered eligible. Among these, we included 14 articles in qualitative synthesis after a full-text assessment [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ]. The other 47 papers were excluded for the following reasons: studies on cadavers ( n = 15) or mannequins ( n = 1), commentaries on the Flex Robotic System without patients ( n = 7), and studies on other robotic systems ( n = 24).…”

“…Among the papers that matched the inclusion criteria, five publications were case reports [ 12 , 13 , 17 , 23 , 24 ], two were case series [ 11 , 16 ], three were retrospective studies [ 18 , 20 , 21 ], and four were prospective studies [ 14 , 15 , 19 , 22 ] ( Table 1 ).…”

“…Four studies regarded patients affected by malignant cancer (HNSCC) [ 12 , 13 , 20 , 21 ], while four studies included only patients with benign pathologies, such as laryngeal papillomatosis, obstructive sleep apnoea syndrome (OSAS), polypoid lesion of the vocal folds, keratotic lesions of the tongue, and submandibular stones [ 16 , 17 , 23 , 24 ]. In the remaining six papers, both malignant and benign diseases were included [ 11 , 14 , 15 , 18 , 19 , 22 ]. The tumour stage was reported in eight articles and ranged from I to IV [ 12 , 13 , 14 , 18 , 19 , 20 , 21 , 22 ].…”

“…In the remaining six papers, both malignant and benign diseases were included [ 11 , 14 , 15 , 18 , 19 , 22 ]. The tumour stage was reported in eight articles and ranged from I to IV [ 12 , 13 , 14 , 18 , 19 , 20 , 21 , 22 ].…”

“…The mean hospital stay was reported in nine studies, ranging from 1 to 18 days [ 11 , 12 , 17 , 18 , 19 , 21 , 22 , 23 , 24 ]. Persky et al observed that the hospital stay was longer for patients affected by a malignant disease (mean 2.45 days) compared to those with benign pathology (mean 0.64 days) [ 18 ].…”