Single-session, dual-site robotic surgery for synchronous primary malignancies of the oropharynx and thorax

Abstract

Single-session, dual-site robotic surgery for synchronous malignancies is not widely reported. To our knowledge, there are no previous reports of transoral robotic surgery (TORS) and robot-assisted thoracic surgery (RATS) in a single sitting. A 49-year-old male presented with a neck lump. Biopsies and imaging proved synchronous primaries of the tonsil and lung. The morbidity of primary dual-site chemoradiotherapy, or open surgery, presented a management challenge. We therefore opted for sequential robotic resections, in a single sitting. The patient was discharged on Day 6 post-operatively and was able to start radiotherapy less than 3 weeks post-operatively. Undertaking TORS and RATS in a single sitting is feasible and safe. This approach allowed fast-tracking of adjuvant oncological therapy, arguably conveying the greatest chance of cure. We detail the rationale and utility of this novel approach and describe the surgical and anaesthetic challenges of two teams undertaking sequential robotic procedures in a single sitting.

Establishing and integrating a transoral robotic surgery programme into routine oncological management of head and neck cancer – a UK perspective

“…Over time, the team became more confident, such that, 16 months after our first case, we successfully performed our first dual-site robotic surgery jointly with thoracic surgeons. 28…”

“…Over time, the team became more confident, such that, 16 months after our first case, we successfully performed our first dual-site robotic surgery jointly with thoracic surgeons. 28 In 24 of the 33 transoral robotic surgery diagnostic procedures performed, the primary tumour site was identified. This had a major impact on management, as these patients were all enrolled in the PATHOS trial, and potentially could avoid chemotherapy or chemo-radiotherapy.…”