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From the Archives
September 2010

Transoral Robotic Surgery: Disruptive 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.

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:   clinicaltrials.gov Identifier: NCT00473564

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