Mini invasive surgery assisted by transoral Da Vinci® robotic in head and neck carcinomas

Objective. The objective of this study was prospectively to assess the feasibility and safety of Transoral Robotic Surgery (TORS) in head and neck carcinomas and to report our learning curve and two year outcomes.Methods. Patients with oropharyngeal, hypopharyngeal and laryngeal tumors treated with TORS were prospectively included. We evaluated: the feasibility of TORS, robotic set-up time, transoral robotic surgery time, blood loss, surgical margins, tracheotomy, feeding tube, time to oral feeding and surgery-related complications and preliminary oncologic outcomes.Results. 50 patients were treated for 52 carcinomas. 49 patients underwent successful robotic resection for 51 carcinomas (98.9 %). One patient required conversion to open surgery due to massive bleeding. The mean robotic set-up time was 25 minutes (range : 15 to 100 minutes) and mean TORS operating time was 70 minutes (range : 20 to 150 minutes). Positive margin of resection was observed in three patients. A tracheotomy was performed in 4 patients. Twelve patients required a nasogastric tube and gastrostomy was performed in the three patients. Complications in the 30-day postoperative period included one pneumonia with aspiration, one alcohol withdrawal, one neck hematoma one neck fistula and one death related to sudden postoperative bleeding occurred on the 15th postoperative day in a patient with total pyriform sinus resection by TORS. The mean hospital stay was 8.4 days (3-29 days).Mean follow-up was 19 months. Four deaths occurred: postoperative (n = 1,2 %), an event linked to oncological (n = 3,6 %).Conclusions. Early-stage selected head and neck cancers can be treated by TORS avoiding the need for tracheotomy and allowing more rapid resumption of swallowing and a shorter hospital stay. Further studies are necessary to confirm these preliminary results and to provide oncological results.