Feasibility and safety of TORS with the Da Vinci XI surgical system. Our initial Athens experience

Abstract

Introduction: Transoral robotic surgery (TORS) is an exciting, rapidly evolving and, since 2009, widely accepted (FDA approved) field that offers a new minimally invasive surgical practice for head and neck diseases. The aim of this study is to assess the feasibility and safety of TORS, using the Da Vinci Xi surgical system, both for therapeutic and diagnostic purposes in head and neck cancer at our institution. Material and methods: From 2018 until today, 11 patients with a minimum follow-up of two years underwent TORS at Hygeia Hospital by a single surgeon with the Da Vinci Xi surgical system. All patients had squamous cell carcinoma (SCCA) of the oropharynx or unknown primary. 6 TORS were therapeutic (radical tonsillectomy and base of tongue resections) and 5 were diagnostic procedures for unknown primaries. Results: All 6 patients who underwent therapeutic surgery had resections with microscopic negative margins. Half of the patients had HPV positive disease. All patients except one remain free of disease until now. Three patients received adjuvant radiotherapy. No patient received chemotherapy. In the diagnostic group the primary tumor was identified in two patients. There were no serious complications. There was only one minor postoperative oropharyngeal bleeding, which was treated successfully with non-operative means. Conclusions: TORS is a safe treatment alternative and it also allows identification of the unknown primary.

Keywords

• Transoral robotic surgery (TORS)
• Oropharyngeal squamous cell carcinoma (OPSCCA)
• Unknown primary
• Therapeutic procedures
• Diagnostic procedures
• Oncologic outcomes