title: Surgeon experience and complications with Transoral Robotic Surgery (TORS).
abstract: OBJECTIVE
  To investigate surgeon preferences for perioperative management of transoral robotic surgery (TORS) and explore the frequency of postoperative complications.
  
  
  METHODS
  Retrospective survey.
  
  
  METHODS
  Multi-institutional.
  
  
  METHODS
  An electronic survey was sent to over 300 TORS-trained surgeons in the United States identified by Intuitive Surgical, Inc. Participation was voluntary and solicited by email invitations to participate 3 times over a 1-month period.
  
  
  RESULTS
  A total of 2015 procedures were reported by 45 respondent TORS-trained surgeons: 67% academic, 33% nonacademic. A minority of TORS procedures (n = 214, 10.6%) were performed on previously irradiated patients. Neck dissections were performed concurrently (58%) or staged (42%). Fewer than 6% of TORS procedures required tracheotomy or reconstruction. Most surgeons (62%) initiated oral intake on postoperative day 0-1. Of the patients who required readmission, bleeding (n = 62, 3.1%) was the most common cause followed by dehydration (n = 26, 1.3%). Other complications of surgery included tooth injury (n = 29, 1.4%), percutaneous endoscopic gastrostomy (PEG) dependency >6 months (n = 21, 1.0%), temporary hypoglossal nerve injury (n = 18, 0.9%), and lingual nerve injury (n = 11, 0.6%). A total of 6 deaths (0.3%) were reported within 30 days of TORS. All reported deaths were due to postoperative hemorrhage. The complication rate decreased significantly with higher surgeon case volume (>50 cases).
  
  
  CONCLUSIONS
  TORS is associated with a low major complication rate, early initiation of oral intake, and a low rate of long-term PEG dependency. Postoperative hemorrhage was the most common cause of hospital readmission and postoperative mortality.
authors.affiliation: Department of Otolaryngology, Medstar Washington Hospital Center, Medstar Georgetown University Hospital, Washington, DC, USA.
authors.forename: Stanley H
authors.initials: SH
authors.lastname: Chia
authors.forename: Neil D
authors.initials: ND
authors.lastname: Gross
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Richmon
mesh_terms: D002277:Carcinoma / Q000150:complications / Q000601:surgery*; D002983:Clinical Competence / Q000592:standards*; D003681:Dehydration / Q000209:etiology; D006801:Humans; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods / Q000401:mortality; D037981:Neck Dissection; D061646:Operative Time; D009959:Oropharyngeal Neoplasms / Q000150:complications / Q000601:surgery*; D010359:Patient Readmission; D019106:Postoperative Hemorrhage / Q000209:etiology; D012189:Retrospective Studies; D012371:Robotics / Q000379:methods; D011795:Surveys and Questionnaires; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States
keywords: TORS; perioperative management; postoperative complications; transoral robotic surgery