Lira Renan Bezerra, Chulam Thiago Celestino, Kowalski Luiz Paulo
Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, Sao Paulo, Brazil.
Gland Surg. 2017 Jun;6(3):258-266. doi: 10.21037/gs.2017.03.17.
In the last three decades, otolaryngology and head and neck oncological surgery have shown remarkable progress with the development of several modalities of endoscopic-assisted minimally invasive surgeries. More recently, the Da Vinci robotic surgery system has promoted the development of several surgical approaches with less morbidity and better cosmetic results, including the transaxillary and retroauricular approaches for thyroid surgery and neck dissections. In South America, there are several shortcomings regarding financial resources as well as the lack of support for innovation leading to a significant delay in adoption of numerous technological advances in medical practice. Despite these obstacles, we obtained training in transoral robotic surgery and neck procedures, and then decided to implement neck endoscopic and robotic surgery at our institution. We developed a collaborative training program with Yonsei University that, together with several local measures, allowed for a safe implementation. From June 2014 to December 2016, we have performed a total of 121 retroauricular neck surgeries, of which 65 were robotic-assisted and 56 were endoscopic assisted procedures, with a complication rate that seems to be comparable to conventional procedures in our experience and a smooth learning curve. Safety compliance has been continuously assessed. Aiming to develop and disseminate these techniques, we have ongoing collaborative work with Yonsei University faculty, to continue increasing our clinical experience, and we are now preparing the group and infrastructure to establish a local training program for South American surgeons. We have been presenting our results at national and international medical meetings and started to publish the preliminary results in peer reviewed medical journals. The emphasis is that a retroauricular approach is a therapeutic option to be considered, especially for young patients. Media exposure has been avoided so far. As expected, resistance by our peers is still present and much more work is needed to overcome it, including the generation of data on the outcomes and a critical analysis of the advantages and disadvantages of endoscopic and robotic neck surgery.
在过去三十年中，随着多种内镜辅助微创手术方式的发展，耳鼻咽喉头颈肿瘤外科取得了显著进展。最近，达芬奇机器人手术系统推动了多种手术方法的发展，这些方法具有更低的发病率和更好的美容效果，包括甲状腺手术和颈部清扫术的经腋窝和耳后入路。在南美洲，在财政资源以及对创新缺乏支持方面存在若干不足，导致在医疗实践中采用众多技术进步出现显著延迟。尽管存在这些障碍，我们还是接受了经口机器人手术和颈部手术的培训，然后决定在我们的机构实施颈部内镜手术和机器人手术。我们与延世大学制定了一项合作培训计划，该计划与一些当地措施一起，实现了安全实施。从2014年6月到2016年12月，我们共进行了121例耳后颈部手术，其中65例是机器人辅助手术，56例是内镜辅助手术，根据我们的经验，其并发症发生率似乎与传统手术相当，并且学习曲线平稳。我们一直在持续评估安全合规情况。为了开发和推广这些技术，我们正在与延世大学的教员开展合作工作，以不断增加我们的临床经验，并且我们现在正在筹备团队和基础设施，为南美外科医生建立一个本地培训项目。我们一直在国内和国际医学会议上展示我们的成果，并开始在同行评审的医学期刊上发表初步结果。重点是耳后入路是一种应被考虑的治疗选择，尤其是对于年轻患者。到目前为止，我们避免了媒体曝光。不出所料，同行的抵制仍然存在，还需要做更多工作来克服它，包括生成关于结果的数据以及对内镜和机器人颈部手术的优缺点进行批判性分析。
