Transoral Robotik Cerrahinin Klinik Pratiğe Adaptasyonu: Tek Merkez Başlangıç Deneyimlerimiz ve Kısa Dönem Sonuçlar

Amaç: Bu çalışmada, transoral robotik cerrahi TORC ile ilgili başlangıç deneyimimizi, TORC’ un klinik pratiğimize uyarlanmasında yaşadığımız sorunları ve hastaların perioperatif ve erken dönem sonuçlarını sunmayı amaçladık.Gereç ve Yöntemler: Cerrahi tedavi gerektiren orofaringeal ve/veya hipofaringeal patoloji nedeniyle Nisan 2015 - Şubat 2018 tarihleri arasında kliniğimizde TORC uygulanan ardışık 70 hasta çalışmaya alındı. Hastaların demografik verileri, klinik bulguları ve perioperatif sonuçları prospektif olarak kaydedildi. Bulgular: Hastaların 60’ı erkek, 10’ u kadındı. Ortalama yaş 44,8±8,3, ortalama vücut kitle indeksi ise 31,9±3,5 kg/m2 idi. En genç hasta dört aylık bir infant idi. Hastaların %68,6’sında Mallampati skoru ≥3 idi. Elli hastaya obstrüktif uyku apnesi OSA nedeniyle dil kökü rezeksiyonu uygulandı. Baş-boyun tümörü olan dokuz hastadan altısına supraglottik parsiyel larinjektomi, ikisine dil kökü rezeksiyonu, bir hastaya da kordektomi uygulandı. Bilateral kord paralizisi olan yedi hastaya posterior kordektomi ile birlikte aritenoidektomi yapıldı. Farklı endikasyonlarla, birer hastaya dil kökünden lenfanjiyom eksizyonu, lingual tiroglossal duktus kisti eksizyonu, valleküler kist eksizyonu ve laringosel eksizyonu yapıldı. Tüm hastalarda TORC başarıyla tamamlandı. Olguların hiçbirinde kan transfüzyonu gerekmedi. Robotik sistemin ortalama kurulum süresi tüm prosedürler için 15 ilâ 18 dakika arasında değişmekte idi. Uygulanan cerrahilerin heterojenitesinden dolayı operasyon süreleri farklılık göstermekteydi. Perioperatif minör komplikasyonlar gözlendi. Dilde ödem, en sık intraoperatif komplikasyondu. Hastanede kalış süreleri cerrahi rezeksiyonların genişliği ile paralel, 1-13 gün arasında değişmekteydi.Sonuç: TORC, açık ve konvansiyonel endoskopik cerrahi ile erişimin güç olduğu orofaringeal ve/veya hipofaringeal patolojilerin cerrahi tedavisinde, minimal perioperatif komplikasyonları olan, etkin bir tedavi yöntemidir

Anahtar Kelimeler:

Transoral robotik cerrahi, Üst hava yolu, Perioperatif sonuçlar

Implementation of Transoral Robotic Surgery into Clinical Practice: Single Institution Initial Experience with Short-term Outcomes

Objective: In this study, we aimed to present our initial experience and challenges that we encountered in adaptation of transoral robotic surgery TORS into our clinical practice, with perioperative and short term outcomes. Material and Methods: A total of 70 consecutive patients who underwent TORS between April 2015 and February 2018 in our clinic due to oropharyngeal and/or hypopharyngeal pathology requiring surgical treatment were included in the study. Demographic data, clinical findings and perioperative outcomes were recorded prospectively.Results: Of the patients, 60 were male and 10 were female. The mean age was 44.8±8.3 years, while mean body mass index was 31.9±3.5 kg/m2. The youngest patient was a 4-month-old infant. Of the patients, 68.6% had a Mallampati score of ≥3. A tongue base resection was performed in 50 patients with obstructive sleep apnea OSA . Of the nine patients with head and neck tumor, six underwent supraglottic partial laryngectomy, two underwent tongue base resection, and one underwent cordectomy. A posterior cordectomy combined with arytenoidectomy was performed in 7 patients with bilateral cord paralysis. Excisions of lymphangioma, lingual thyroglossal duct cyst, vallecular cyst and laryngocele were performed in one patient each with different indications. TORS was completed in all patients successfully. A blood transfusion was not needed in any patient. The mean robotic set-up time for all procedures was in the range of 15 to 18 minutes. Due to the heterogeneity of surgeries performed, operation times differed between procedures. Minor perioperative complications were observed. Tongue edema was the most common intraoperative complication. The length of hospital stay was in the range of 1 to 13 days in parallel with the extent of surgical resections.Conclusion: TORS is an effective treatment approach with minimal perioperative complications in the surgical treatment of oropharyngeal and/or hypopharyngeal pathologies that are difficult to access via open or conventional endoscopic surgery

Keywords:

Transoral robotic surgery, Upper airway, Perioperative outcomes,

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Hockstein NG, Nolan JP, O’malley BW Jr, Woo YJ. Robotic microlaryngeal surgery: A technical feasibility study using the daVinci surgical robot and an airway mannequin. Laryngoscope 2005;115:780-5.
Hockstein NG, Nolan JP, O’Malley BW Jr, Woo YJ. Robot-assisted pharyngeal and laryngeal microsurgery: Results of robotic cadaver dissections. Laryngoscope 2005;115:1003-8.
Remacle M, Hantzakos A, Eckel H, Evrard AS, Bradley PJ, Chevalier D, Djukic V, de Vincentiis M, Friedrich G, Olofsson J, Peretti G, Quer M, Werner J. Endoscopic supraglottic laryngectomy: A proposal for a classification by the working committee on nomenclature, European Laryngological Society. Eur Arch Otorhinolaryngol 2009;266:993-8.
Vicini C, Dallan I, Canzi P, Frassineti S, La Pietra MG, Montevecchi F. Transoral robotic tongue base resection in obstructive sleep apnoea-hypopnoea syndrome: A preliminary report. ORL J Otorhinolaryngol Relat Spec 2010;72:22-7.
Park YM, Kim WS, Byeon HK, De Virgilio A, Jung JS, Kim SH. Feasiblity of transoral robotic hypopharyngectomy for early-stage hypopharyngeal carcinoma. Feasibility of transoral robotic hypopharyngectomy for early-stage hypopharyngeal carcinoma. Oral Oncol 2010;46:597- 602.
Maan ZN, Gibbins N, Al-Jabri T, D’Souza AR. The use of robotics in otolaryngology-head and neck surgery: A systematic review. Am J Otolaryngol 2012;33:137-46.
Gross ND, Holsinger FC, Magnuson JS, Duvvuri U, Genden EM, Ghanem TA, Yaremchuk KL, Goldenberg D, Miller MC, Moore EJ, Morris LG, Netterville J, Weinstein GS, Richmon J. Robotics in otolaryngology and head and neck surgery: Recommendations for training and credentialing: A report of the 2015 AHNS education committee, AAO-HNS robotic task force and AAO-HNS sleep disorders committee. Head Neck 2016;38 Suppl 1:E151-8.
Albergotti WG, Gooding WE, Kubik MW, Geltzeiler M, Kim S, Duvvuri U, Ferris RL. Assessment of surgical learning curves in transoral robotic surgery for squamous cell carcinoma of the oropharynx. JAMA Otolaryngol Head Neck Surg 2017;143:542-8.
Genden EM, Desai S, Sung CK. Transoral robotic surgery for the management of head and neck cancer: A preliminary experience. Head Neck 2009;31:283-9.
Lawson G, Matar N, Remacle M, Jamart J, Bachy V. Transoral robotic surgery for the management of head and neck tumors: Learning curve. Eur Arch Otorhinolaryngol 2011;268:1795-80.
Roh JL, Kim DH, Park CI. Voice, swallowing and quality of life in patients after transoral laser surgery for supraglottic carcinoma. J Surg Oncol 2008;98:184-9.
Mendelsohn AH, Remacle M, Van Der Vorst S, Bachy V, Lawson G. Outcomes following transoral robotic surgery: supraglottic laryngectomy. Laryngoscope 2013;123:208- 14.
Park YM, Kim WS, Byeon HK, Lee SY, Kim SH. Surgical techniques and treatment outcomes of transoral robotic supraglottic partial laryngectomy. Laryngoscope 2013;123:670-7.
Vergez S, Lallemant B, Ceruse P, Moriniere S, Aubry K, De Mones E, Benlyazid A, Mallet Y. Initial multi- institutional experience with transoral robotic surgery. Otolaryngol Head Neck Surg 2012;147:475-81.
Weinstein GS, O’Malley BW Jr, Magnuson JS, Carroll WR, Olsen KD, Daio L, Moore EJ, Holsinger FC. Transoral robotic surgery: a multicenter study to assess feasibility, safety, and surgical margins. Laryngoscope 2012;122:1701-7.
Bhayani MK, Holsinger FC, Lai SY. A shifting paradigm for patients with head and neck cancer: Transoral robotic surgery (TORS). Oncology (Williston Park). 2010;24:1010-5.