title: Initial multi-institutional experience with transoral robotic surgery.
abstract: OBJECTIVE
  To assess the initial experience for transoral robotic surgery (TORS), as observed in the French TORS group.
  
  
  METHODS
  A multi-institutional prospective cohort study.
  
  
  METHODS
  Seven tertiary referral centers.
  
  
  METHODS
  One hundred thirty consecutive patients who were scheduled for a TORS between October 2008 and March 2011 were included. The operative times, conversion rates, morbidity, and alternatives were described. The serious adverse effects encountered were analyzed, and recommendations for avoiding them are specified.
  
  
  RESULTS
  Most of the patients (65%) had a laryngeal (supraglottic) and/or hypopharyngeal resection. Thirty-nine of the 130 patients receiving TORS would have had a transoral laser resection as their alternative surgery. The tumor exposure was suboptimal in 26% of the cases. Six of the 130 patients needed conversion to an open approach. There were 15 postoperative hemorrhages and 2 deaths due to posthemorrhage complications in patients with significant comorbidities at 9 and 18 days after the surgery. The median setup and procedure times were 52 ± 46 and 90 ± 92 minutes, respectively. The learning curve was characterized by better selection and management of potential patients.
  
  
  CONCLUSIONS
  The visualization offered by the robotic assistance allowed transoral resections of tumors that were difficult to resect or unresectable by laser surgery. Self-assessment of surgical exposure and a decrease in the need to convert to an open procedure over time suggested improvement in TORS-related surgical skills. Nevertheless, strict patient selection is essential. Even with a minimally invasive approach, some patients will need a tracheostomy for safety reasons.
authors.affiliation: Otolaryngology, Head and Neck Surgery Department, University Hospital Rangueil-Larrey, Toulouse, France. vergez.s@chu-toulouse.fr
authors.forename: Sebastien
authors.initials: S
authors.lastname: Vergez
authors.forename: Benjamin
authors.initials: B
authors.lastname: Lallemant
authors.forename: Philippe
authors.initials: P
authors.lastname: Ceruse
authors.forename: Sylvain
authors.initials: S
authors.lastname: Moriniere
authors.forename: Karine
authors.initials: K
authors.lastname: Aubry
authors.forename: Erwan
authors.initials: E
authors.lastname: De Mones
authors.forename: Adil
authors.initials: A
authors.lastname: Benlyazid
authors.forename: Yann
authors.initials: Y
authors.lastname: Mallet
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D005260:Female; D006470:Hemorrhage / Q000209:etiology / Q000401:mortality; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000473:pathology / Q000601:surgery*; D007818:Laryngeal Diseases / Q000601:surgery; D007822:Laryngeal Neoplasms / Q000473:pathology / Q000601:surgery*; D007828:Laryngoscopy / Q000193:education / Q000379:methods*; D053685:Laser Therapy / Q000379:methods; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D009096:Multi-Institutional Systems; D009367:Neoplasm Staging; D009959:Oropharyngeal Neoplasms / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D012371:Robotics / Q000193:education / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000193:education / Q000379:methods*