Abstract

BUSTO, Eduardo  and  PATRUCCO, Marta. Initial experience with transoral robotic surgery (TORS) in Buenos Aires. Rev. argent. cir. [online]. 2020, vol.112, n.2, pp.141-156. ISSN 2250-639X.

Background: robotic surgery is an alternative to open surgery, CO₂ laser microsurgery, or chemoradiation for the upper aero-digestive tract. This system allows surgeons to use the open surgical technique in a minimally invasive approach through the mouth to treat benign and malignant disorders. Different treatments are currently used with similar oncologic outcomes. Objective: the aim of this study was to introduce a surgical tool through transoral approach, report the initial experience with the use of the robotic system, evaluate respiratory and digestive functional preservation and analyze the variables associated with shorter hospital length of stay. Material and methods: A total of 24 patients (13 women and 11 men, mean age 55.08 years [16-82]) were included. Eight patients had chronic inflammatory disease, four had benign tumors and 12 had cancer. The variables considered in robotic surgery were hospital length of stay, place of postoperative care, complications, respiratory and swallowing function and use of reconstructive techniques. Flexible endoscopic evaluation of swallowing was performed to document safe function. Results: mean length of stay was 1.92 days; 83.3% stayed for one day; 79.9% were admitted to the general ward and 20.1% stayed in intensive or intermediate care units. None of the patients required tracheostomy. Healing of the surgical bed occurred by secondary intention. There were no complications. Tongue edema occurred in two patients. Conclusions: robotic surgery favors tumor removal with low morbidity and maximum preservation of healthy tissues while reducing postoperative edema, use of flaps for reconstruction, temporary tracheostomy and hospital length of stay. Flexible endoscopic evaluation of swallowing is useful to determine safe swallowing function. The main limitation of our study is the sample size. It is important to increase the number of patients to evaluate survival and quality of life.

Keywords : Ttransoral robotic surgery; TORS; Minimally invasive transoral surgery; Swallowing videoendoscopy; FEESST; Tongue swelling; Tracheostomy; Length of hospital stay; Transoral robotic surgery; Adverse events.

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