Transoral robotic surgery: radical tonsillectomy.
OBJECTIVE
To describe and show the feasibility of a new surgical technique for transoral robotic surgery (TORS) radical tonsillectomy.


METHODS
A prospective, phase 1 clinical trial.


METHODS
Academic, tertiary referral center.


METHODS
A total of 27 participants were prospectively selected using a volunteer sample. All eligible patients agreed to participate in the study.


METHODS
Patients underwent TORS radical tonsillectomy for previously untreated invasive squamous cell carcinoma of the tonsillar region without free-flap reconstruction, staged neck dissection, and adjuvant therapy.


METHODS
Outcome measures included final pathologic margin status, need for short- and long-term tracheotomy tube placement, and need for gastrostomy tube feedings among patients with a minimum 6-month follow-up. The incidence of significant postoperative complications was recorded.


RESULTS
No mortality occurred. Final margins found to be negative for cancer were achieved in 25 of 27 patients (93%). Surgical complications included 1 case each of postoperative mucosal bleeding, delirium tremens, unplanned tracheotomy for temporary exacerbation of sleep apnea, and hypernasality and 2 cases of moderate trismus. Twenty-six of 27 patients (96%) were swallowing without the use of a gastrostomy.


CONCLUSIONS
Radical tonsillectomy using TORS is a new technique that offers excellent access for resection of carcinomas of the tonsil with acceptable acute morbidity. Future reports will focus on long-term oncologic and functional outcomes.
Weinstein
Gregory S
GS
Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, PA 19104, USA. gregory.weinstein@uphs.upenn.edu
O'Malley
Bert W
BW
Snyder
Wendy
W
Sherman
Eric
E
Quon
Harry
H
D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D019723:Endoscopes; D004724:Endoscopy / Q000379:methods*; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009055:Mouth; D011446:Prospective Studies; D012371:Robotics / Q000295:instrumentation*; D014067:Tonsillar Neoplasms / Q000473:pathology / Q000601:surgery*; D014068:Tonsillectomy / Q000295:instrumentation*; D016896:Treatment Outcome