Résumé
Objective: Assess the learning curve of transoral robotic surgery (TORS) observed in the French TORS group, gathering 7 different tertiary referral centers. The oncologic results are presented separately.
Method: A multi-institutional prospective record was done between 2008 and 2010. A total of 76 consecutive patients scheduled for a TORS have been included. The benefits observed with this technique, the operative times, conversion rate, and morbidity are described. The pitfalls encountered are detailed and responses are formulated to avoid them.
Results: Most patients had a laryngeal (supraglottic) and/or hypopharyngeal resection (65%). 30/76 patients operated by TORS would have had a transoral laser resection as alternative surgery. Tumor exposure was suboptimal in 24% of cases. Two out of 76 conversions in open-approach were necessary. In the beginning, there were 2 deaths due to complications after hemorrhage in patients with high co-morbidities. The median-time of set-up and procedure were respectively 60 ± 55 and 120 ± 89 minutes. The learning curve was characterized by a decrease of these durations in all the centers (P = ns), a better selection and management of patients candidates.
Conclusion: Excellent visualization and skill offered by the robotic assistance allowed transoral resection of tumors unresectable with laser surgery. Surgeons improved rapidly their exposure and resection abilities. Nevertheless, a strict selection of patients is essential. Even with a minimal invasive intent, some of them need a tracheostomy for safety reasons.