How safe and effective is the da Vinci Surgical System in transoral robotic-assisted surgery for benign indications, including obstructive sleep apnea (OSA)?
Background: In the past two decades, the need for minimally invasive techniques for transoral head and neck surgical procedures has grown, but there are limitations including endoscope field of vision and depth perception, and length of surgery on procedures such as partial glossectomies that may result in edema. Robot-assisted technology was investigated as a means to overcome the surgical limitations associated with current techniques.
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May 2015Study design: Multicenter, single-arm, retrospective case series of 293 TORS procedures performed in 285 patients between Jan. 1, 2010, and Oct. 31, 2013.
Setting: Department of Surgery, St. Joseph Mercy Health System, Ann Arbor, Michigan; Department of Surgery, Middlesex Hospital, Middletown, Connecticut; Department of Otorhinolaryngology–Head and Neck Surgery, University of Pennsylvania, Philadelphia.
Synopsis: The majority of the patients were male and Caucasian, with at least one comorbidity and had an OSA diagnosis. Eight patients required revision surgery to resect additional tissue. The types of initial and revision surgeries for each patient were similar. The average time period between the two separate procedures was 8.1 months. The 293 procedures included lingual tonsillectomy alone or with base of tongue resection. The most common concomitant nonrobotic procedures were uvulopalatopharyngoplasty (UPPP), lateral pharyngoplasty, palatine tonsillectomy, and palatal Z-plasty. The average overall operative time, including all concomitant procedures, was 86.7 minutes, the estimated intra-operative blood loss was 27.5 mL, and the average tissue volume resected was 8.3 mL. Fifty-nine patients experienced a total of 77 complications within the three-month follow-up period, including complications related to the TORS procedures as well as any concomitant robotic and nonrobotic procedures conducted during the same operation. There were no complications specifically related to the use of the da Vinci Surgical System.
Bottom line: It is safe and feasible to use the da Vinci Surgical System to perform lingual tonsillectomy and base of tongue resection procedures for benign indications.
Citation: Hoff PT, D’Agostino MA, Thaler ER. Transoral robotic surgery in benign diseases including obstructive sleep apnea: safety and feasibility. Laryngoscope. 2015;125:1249-1253.
—Reviewed by Amy Hamaker