Head and Neck Surgery Center of Florida, Florida Hospital Celebration Health, Celebration, FL 34747, USA.
JAMA Otolaryngol Head Neck Surg. 2013 Jun;139(6):564-7. doi: 10.1001/jamaoto.2013.3007.
As new institutions incorporate transoral robotic surgery (TORS) into their everyday practice, it is helpful to have a timeline reference of expected goals to follow as their experience increases. This article evaluates a single tertiary care academic institution's experience with TORS for head and neck tumors and reports its 4-year learning curve.
To evaluate a single institution's experience with TORS over a 4-year period and report treatment trends and clinical outcomes.
Prospective case study.
A single tertiary care academic institution.
A total of 168 patients underwent TORS for tumors of the head and neck at University of Alabama at Birmingham between March 2007 and September 2011. The total group was subdivided into 4 consecutive groups (42 patients each). Patients were monitored throughout their hospital stay and up to 4.5 years postoperatively (mean follow-up duration, 14 months).
Transoral robotic surgery.
Data points were collected and compared over time, including feasibility, operative time, tumor type, stage, subsite, length of intubation, need for tracheostomy, feeding tube use, hospital stay, margin status, neck dissection performed, and postoperative complications.
Significant decreases in operative time, length of intubation, and hospital stay were seen as TORS experience increased. Overall, the mean operative time decreased by 47% (group 4, 86 minutes; group 1, 183 minutes). Total mean intubation time decreased by 87% (group 1, 12.9 hours; group 4, 1.7 hours) and mean hospital stay decreased from 3.0 days to 1.4 days. There was not a significant difference between groups in number of cases unable to be performed robotically (7-9 per group), tumor stage (majority T1/T2), tumor subsite (majority oropharynx), positive margin status (2-5 per group), number of salvage cases performed (7-9 per group), and number of tracheostomies (2-4 per group) or feeding tubes (22-25 per group) required.
This is the first multiyear prospective study to document a single institution's TORS experience over time and demonstrate particular areas of expected improvement as case number increases.
随着新机构将经口机器人手术（TORS）纳入日常实践，了解随着经验的增加，预期目标的时间线参考是有帮助的。本文评估了一家三级保健学术机构在头颈部肿瘤 TORS 方面的经验，并报告了其 4 年的学习曲线。
评估一家机构在 4 年内使用 TORS 的经验，并报告治疗趋势和临床结果。
前瞻性病例研究。
一家三级保健学术机构。
2007 年 3 月至 2011 年 9 月，阿拉巴马大学伯明翰分校共有 168 例头颈部肿瘤患者接受 TORS 治疗。总共有 4 个连续组（每组 42 例）。在整个住院期间和术后 4.5 年（平均随访时间 14 个月）对患者进行监测。
经口机器人手术。
随着时间的推移收集和比较数据点，包括可行性、手术时间、肿瘤类型、分期、部位、插管时间、气管切开术需要、使用饲管、住院时间、切缘状态、行颈部清扫术和术后并发症。
随着 TORS 经验的增加，手术时间、插管时间和住院时间显著缩短。总的来说，手术时间平均缩短 47%（第 4 组 86 分钟；第 1 组 183 分钟）。总平均插管时间缩短 87%（第 1 组 12.9 小时；第 4 组 1.7 小时），平均住院时间从 3.0 天缩短至 1.4 天。每组无法进行机器人手术的病例数（每组 7-9 例）、肿瘤分期（多数 T1/T2）、肿瘤部位（多数口咽）、阳性切缘状态（每组 2-5 例）、需要进行挽救性手术的病例数（每组 7-9 例）、气管切开术（每组 2-4 例）或饲管（每组 22-25 例）的数量之间无显著差异。
这是第一项多年前瞻性研究，记录了一家机构随时间推移使用 TORS 的经验，并证明了随着病例数量的增加，预期会有特定的改进领域。
