Otolaryngology, Head and Neck Surgery Department, University Hospital Rangueil-Larrey, Toulouse, France.
Otolaryngol Head Neck Surg. 2012 Sep;147(3):475-81. doi: 10.1177/0194599812443221. Epub 2012 Apr 3.
To assess the initial experience for transoral robotic surgery (TORS), as observed in the French TORS group.
A multi-institutional prospective cohort study.
Seven tertiary referral centers.
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.
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.
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.
评估法国经口机器人手术（TORS）组观察到的 TORS 的初步经验。
多机构前瞻性队列研究。
七个三级转诊中心。
纳入 2008 年 10 月至 2011 年 3 月期间计划进行 TORS 的 130 例连续患者。描述了手术时间、转化率、发病率和替代方法。分析了遇到的严重不良事件，并提出了避免这些事件的建议。
大多数患者（65%）接受了喉（声门上）和/或下咽切除术。在接受 TORS 的 130 例患者中，有 39 例将接受经口激光切除术作为替代手术。26%的病例肿瘤暴露不理想。6 例患者需要转为开放手术。在有明显合并症的患者中，术后 9 天和 18 天分别有 15 例术后出血和 2 例因出血并发症死亡。中位设置和手术时间分别为 52±46 分钟和 90±92 分钟。学习曲线的特点是更好地选择和管理潜在患者。
机器人辅助提供的可视化允许对激光手术难以切除或无法切除的肿瘤进行经口切除。对手术暴露的自我评估以及随着时间的推移减少对开放手术的需求表明 TORS 相关手术技能有所提高。然而，严格的患者选择至关重要。即使采用微创方法，出于安全原因，一些患者仍需要气管造口术。
