Initial Multi-institutional Experience with Transoral Robotic Surgery
Initial Multi-institutional Experience with Transoral Robotic Surgery
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DOI：
10.1177/0194599812443221
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发表时间：
2012-09-01
影响因子：
3.4
通讯作者：
Mallet, Yann
中科院分区：
文献类型：
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作者：
Vergez, Sebastien;Lallemant, Benjamin;Mallet, Yann
目标。评估经口腔机器人手术(TORS)的初步经验，就像法国Tors小组观察到的那样。一项多机构前瞻性队列研究。七个第三转诊中心。研究对象和方法。纳入了在2008年10月至2011年3月期间连续接受Tors治疗的130名患者。描述了手术时间、中转率、并发症和替代方案。对发生的严重不良反应进行了分析，并提出了避免的建议。大多数患者(65%)接受了喉(声门上型)和/或下咽切除术。在接受TORS治疗的130名患者中，有39名将接受经口腔激光切除术作为替代手术。26%的病例肿瘤暴露不佳。130名患者中有6名需要转换为开放手术。在术后第9天和第18天有明显并发症的患者中，有15例术后出血，2例死于出血后并发症。中位准备时间为52±46分钟，中位手术时间为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技术可以对难以切除或无法通过激光手术切除的肿瘤进行经口切除。手术暴露的自我评估和随着时间的推移转向开放手术的需要的减少表明与Tors相关的手术技能的改进。然而，严格的患者选择是至关重要的。即使采用微创方法，出于安全原因，一些患者仍需要进行气管切开术。
Objective. To assess the initial experience for transoral robotic surgery (TORS), as observed in the French TORS group.Study Design. A multi-institutional prospective cohort study.Setting. Seven tertiary referral centers.Subjects and Methods. 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.Results. 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.Conclusion. 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.