title: Transoral robotic surgery for the management of head and neck tumors: learning curve.
abstract: Transoral robotic surgery (TORS) is an emerging technique for the treatment of head and neck tumors. The objective of this study is to describe our first steps and present our experience on the technical feasibility, safety, and efficacy of TORS for the treatment of selected malignant lesions. From April 2008 to September 2009, 24 patients were enrolled in this prospective trial. Inclusion criteria were: adults with T1, T2 and selected T3 tumors involving the oral cavity, pharynx, and supraglottic larynx and a signed informed consent was obtained from the patient. Exclusion criteria were: tumors not accessible to TORS after unsuccessful attempts to expose properly the lesion to operate. The ethical committee's approval was obtained to perform this study. Twenty-four patients were included in this study: 10 supraglottic tumors, 10 pharyngeal tumors and 4 oral cavity tumors. Nine patients had T1 tumors, 12 had T2 tumors, and 1 patient had a T3 tumor. In all cases, tumor resection could be performed by robotic surgery exclusively and negative resection margins were achieved with control by frozen section. None of them received intraoperative reconstruction. None of the patients required tracheotomy. There was no intraoperative complication related to the use of the robot. The average setup time was 24 ± 14 min (range 10-60 min). The average surgical time was 67 ± 46 min (range 12-180 min). Surgical and setup time decreased after the first cases. The mean hospital stay was 9 days. Oral feeding was resumed at 3 days. TORS seems to be a safe, feasible, minimally invasive treatment modality for malignant head and neck tumors with a short learning curve for surgeons already experienced in endoscopic surgery.
authors.affiliation: Otolaryngology-Head and Neck Surgery Department, Louvain University Hospital of Mont-Godinne, Dr Therasse Avenue No. 1, Yvoir, Belgium.
authors.forename: Georges
authors.initials: G
authors.lastname: Lawson
authors.forename: Nayla
authors.initials: N
authors.lastname: Matar
authors.forename: Marc
authors.initials: M
authors.lastname: Remacle
authors.forename: Jacques
authors.initials: J
authors.lastname: Jamart
authors.forename: Vincent
authors.initials: V
authors.lastname: Bachy
mesh_terms: D000328:Adult; D000368:Aged; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009055:Mouth; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D009367:Neoplasm Staging; D013517:Otorhinolaryngologic Surgical Procedures / Q000295:instrumentation*; D011446:Prospective Studies; D012371:Robotics / Q000295:instrumentation*; D013997:Time Factors; D016896:Treatment Outcome