From the Archives
September 2010

Transoral Robotic SurgeryDisruptive or Sustaining Innovation?

Author Affiliations

Author Affiliations: Departments of Otolaryngology, Head and Neck Surgery (Drs Couch and Zanation), and Surgery (Dr Couch), University of North Carolina, Chapel Hill, North Carolina.


Copyright 2010 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2010

Arch Surg. 2010;145(9):907-908. doi:10.1001/archsurg.2010.173

Archives of Otolaryngology and Head & Neck Surgery

Robotic-Assisted Surgery for Primary or Recurrent Oropharyngeal Carcinoma

Nichole R. Dean, DO; Eben L. Rosenthal, MD; William R. Carroll, MD; John P. Kostrzewa, MD; Virginia L. Jones, BS; Renee’ A. Desmond, DVM, PhD; Lisa Clemons, RN; J. Scott Magnuson, MD

Objective:   To determine the feasibility of robotic-assisted salvage surgery for oropharyngeal cancer.

Design:   Retrospective case-controlled study.

Setting:   Academic, tertiary referral center.

Patients:   Patients who underwent surgical resection for T1 and T2 oropharyngeal cancer between 2001 and 2008 were classified into the following 3 groups based on type of resection: (1) robotic-assisted surgery for primary neoplasms (robotic primary) (n = 15), (2) robotic-assisted salvage surgery for recurrent disease (robotic salvage) (n = 7), and (3) open salvage resection for recurrent disease (n = 14).

Main Outcome Measures:   Data regarding tumor subsite, stage, and prior treatment were evaluated as well as margin status, nodal disease, length of hospital stay, diet, and tracheotomy tube dependence.

Results:   The median length of stay in the open salvage group was longer (8.2 days) than robotic salvage (5.0 days) (P = .14) and robotic primary (1.5 days) resection groups (P < .001). There was no difference in postoperative diet between robotic primary and robotic salvage surgery groups. However, a greater proportion of patients who underwent open salvage procedures were gastrostomy tube dependent 6 months following treatment (43%) compared with robotic salvage resection (0%) (P = .06). A greater proportion of patients who underwent open salvage procedures also remained tracheotomy tube dependent after 6 months (7%) compared with robotic salvage or robotic primary patients (0%) (P = .48). No complications were reported in the robotic salvage group. Two patients who underwent open salvage resection developed postoperative hematomas and 2 developed wound infections.

Conclusion:   When feasible, robotic-assisted surgery is an acceptable procedure for resection of both primary and recurrent oropharyngeal tumors.

Trial Registration: Identifier: NCT00473564