Implementation of a TORS program in an academic medical center

Richmon, Jeremy D.; Agrawal, Nishant; Pattani, Kavita M.

doi:10.1002/lary.21750

Cited by 18 publications

(7 citation statements)

References 20 publications

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“…In contrast to non-TORS surgical approaches in which pharyngotomy and mandibulotomy are frequently required for access, multiple institutional series have demonstrated TORS to have short hospital length of stays (LOS) and decreased morbidity and mortality. [17][18][19][20][21] Our analysis of nationwide inpatient data demonstrates that TORS is associated with a decreased length of hospital stay and hospitalrelated costs, and also is associated with a lower rate of gastrostomy tube and tracheotomy tube placement compared to other surgical techniques. Furthermore, we found that TORS is not associated with acute morbidity and mortality.…”

Section: Discussionmentioning

confidence: 99%

The effect of transoral robotic surgery on short‐term outcomes and cost of care after oropharyngeal cancer surgery

Richmon¹,

Quon

Gourin³

2013

The Laryngoscope

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Section: Discussionmentioning

confidence: 99%

The effect of transoral robotic surgery on short‐term outcomes and cost of care after oropharyngeal cancer surgery

Richmon¹,

Quon

Gourin³

2013

The Laryngoscope

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“…In the present study, there was no significant difference in operation time and console time between the earlier and later cases and correlation of console time with specimen size was significant. Another study reported that there were no significant differences in either of the two times between the initial and subsequent 10 cases or the first 15 and last 5 cases [ 20 ]. On the other hand, White et al [ 21 ] reported that the operating time decreased as experience with TORS increased.…”

Section: Discussionmentioning

confidence: 99%

Preliminary study of transoral robotic surgery for pharyngeal cancer in Japan

et al. 2015

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Transoral robotic surgery (TORS) with the da Vinci Surgical System has been used for the removal of pharyngeal and laryngeal cancers with the objective to improve functional and aesthetic outcomes without worsening survival. While TORS has been approved in many countries, Japan’s FDA has not yet done so. Our hospital started using TORS with the approval of the Ethical Review Board and the Minimum Invasive Surgical Center Committee at Tottori University. No surgical outcomes of TORS for Japanese patients with head and neck cancer have been reported in Japan. This paper deals with the outcomes and feasibility of TORS for Japanese patients with pharyngeal cancer at our institution. TORS was performed for 10 patients with T1, T2, T3 oropharyngeal and hypopharyngeal squamous cell carcinoma between 2013 and 2014. This is a single-institutional study. TORS could be completed for all cases, except one patient that was not candidate, and no intraoperative conversion to an open surgical procedure was required. Five patients underwent neck dissection, two of them concurrent and three staged. Of all patients, positive surgical margins were detected in two. The average blood loss including neck dissection was 21.5 ± 33.4 ml, the operation time was 183 ± 36 min and the console time was 103 ± 22 min. No tracheostomy had been performed either pre- or postoperatively, and there was no difference between preoperative and postoperative swallowing functions. In this single-institutional preliminary study, we demonstrated that TORS is a feasible and safe treatment. A clinical multi-institutional study of TORS for laryngopharyngeal cancer has been approved as an advanced medical system study and is under way. In the near future, it is expected that the efficacy and safety of TORS for laryngopharyngeal cancer will be confirmed as the result of this multiple-institutional clinical study in Japan.

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“…A recent report in the literature discussed the implementation of a TORS program in a tertiary academic medical center and outlined a suggested plan to rapidly achieve an acceptable "steady-state of efficiency." 8 One of the goals of this article was to highlight certain expected milestones that may reasonably be achieved after a set number of cases are performed. Programs that are in the beginning phase of their TORS experience commonly want to know how many cases it will take to achieve a reasonable operative time, among other end points.…”

Section: Discussionmentioning

confidence: 99%

Learning Curve for Transoral Robotic Surgery<subtitle>A 4-Year Analysis</subtitle><alt-title>Learning Curve for Transoral Robotic Surgery</alt-title>

White

Frederick²,

Zimmerman³

et al. 2013

JAMA Otolaryngol Head Neck Surg

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Importance:As new institutions incorporate transoral robotic surgery (TORS) into their everyday practice, it is helpful to have a timeline reference of expected goals to follow as their experience increases. This article evaluates a single tertiary care academic institution's experience with TORS for head and neck tumors and reports its 4-year learning curve.Objective: To evaluate a single institution's experience with TORS over a 4-year period and report treatment trends and clinical outcomes.Design: Prospective case study. Results: Significant decreases in operative time, length of intubation, and hospital stay were seen as TORS experience increased. Overall, the mean operative time decreased by 47% (group 4, 86 minutes; group 1, 183 minutes). Total mean intubation time decreased by 87% (group 1, 12.9 hours; group 4, 1.7 hours) and mean hospital stay decreased from 3.0 days to 1.4 days. There was not a significant difference between groups in number of cases unable to be performed robotically (7-9 per group), tumor stage (majority T1/T2), tumor subsite (majority oropharynx), positive margin status (2-5 per group), number of salvage cases performed (7-9 per group), and number of tracheostomies (2-4 per group) or feeding tubes (22-25 per group) required. Conclusions and Relevance:This is the first multiyear prospective study to document a single institution's TORS experience over time and demonstrate particular areas of expected improvement as case number increases.

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Implementation of a TORS program in an academic medical center

Abstract: The introduction of a TORS program in an academic medical center can be a complex and daunting undertaking. We demonstrate that with careful planning, excellent efficiency and safety can be attained immediately.

Cited by 18 publications

References 20 publications

The effect of transoral robotic surgery on short‐term outcomes and cost of care after oropharyngeal cancer surgery

The effect of transoral robotic surgery on short‐term outcomes and cost of care after oropharyngeal cancer surgery

Preliminary study of transoral robotic surgery for pharyngeal cancer in Japan

Learning Curve for Transoral Robotic Surgery<subtitle>A 4-Year Analysis</subtitle><alt-title>Learning Curve for Transoral Robotic Surgery</alt-title>

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