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Maniaci A, Chiesa Estomba C, Fakhry N, Vaira LA, Remacle M, Cammaroto G, Barillari MR, Iannella G, Mayo-Yanez M, Saibene AM, Baudouin R, Maza-Solano J, Mendelsohn AH, Holsinger FC, Ceccon FP, Haddad L, Hans S, La Mantia I, Cocuzza S, Gulinello F, Ayad T, Lechien JR. Influence of Otolaryngological Subspecialties on Perception of Transoral Robotic Surgery: An International YO-IFOS Survey. J Pers Med 2023; 13:1717. [PMID: 38138944 PMCID: PMC10744671 DOI: 10.3390/jpm13121717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/04/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND To investigate perception, adoption, and awareness on the part of otolaryngology and head and neck surgeons (OTO-HNS) of transoral robotic surgery (TORS). METHODS Several items assessed: awareness/perception; access to TORS; training; indications and advantages/hurdles to TORS practice. A subanalysis was performed to assess differences according to the identified otolaryngological subspecialties. RESULTS A total of 359 people completed the survey. Among subspecialties, while for otolaryngologists 30/359 (8.4%) and H&N surgeons 100/359 (27.9%) TORS plays an effective role in hospital stay, laryngologists frequently disagreed (54.3%). There was a lower incidence among rhinologists and otologists (1.9%). Pediatric surgeons (0.8%) reported a positive response regarding the adoption of robotic surgery, and head and neck specialists expressed an even greater response (14.2%). Low adherence was related to perceived cost-prohibitive TORS, by 50% of H&N surgeons. CONCLUSIONS Perception, adoption, and knowledge about TORS play a key role in the application of the robotic system, significantly varying across subspecialties.
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Affiliation(s)
- Antonino Maniaci
- Robotics Study Group of Young Otolaryngologists, International Federation of Oto-Rhino-Laryngological Societies, 75000 Paris, France; (C.C.E.); (N.F.); (L.A.V.); (G.C.); (M.R.B.); (G.I.); (M.M.-Y.); (A.M.S.); (R.B.); (J.M.-S.); (T.A.); (J.R.L.)
- Faculty of Medicine and Surgery, University of Enna “Kore”, 94100 Enna, Italy
- Department of Oto-Rhino-Laryngology Head and Neck Surgery, La Conception University Hospital, AP-HM, Aix Marseille Univ, 13005 Marseille, France
| | - Carlos Chiesa Estomba
- Robotics Study Group of Young Otolaryngologists, International Federation of Oto-Rhino-Laryngological Societies, 75000 Paris, France; (C.C.E.); (N.F.); (L.A.V.); (G.C.); (M.R.B.); (G.I.); (M.M.-Y.); (A.M.S.); (R.B.); (J.M.-S.); (T.A.); (J.R.L.)
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Universitario Donostia, 20003 San Sebastian, Spain
| | - Nicolas Fakhry
- Robotics Study Group of Young Otolaryngologists, International Federation of Oto-Rhino-Laryngological Societies, 75000 Paris, France; (C.C.E.); (N.F.); (L.A.V.); (G.C.); (M.R.B.); (G.I.); (M.M.-Y.); (A.M.S.); (R.B.); (J.M.-S.); (T.A.); (J.R.L.)
- Department of Oto-Rhino-Laryngology Head and Neck Surgery, La Conception University Hospital, AP-HM, Aix Marseille Univ, 13005 Marseille, France
| | - Luigi Angelo Vaira
- Robotics Study Group of Young Otolaryngologists, International Federation of Oto-Rhino-Laryngological Societies, 75000 Paris, France; (C.C.E.); (N.F.); (L.A.V.); (G.C.); (M.R.B.); (G.I.); (M.M.-Y.); (A.M.S.); (R.B.); (J.M.-S.); (T.A.); (J.R.L.)
- Maxillofacial Surgery Unit, University Hospital of Sassari, 07025 Sassari, Italy
| | - Marc Remacle
- Department of Otorhinolaryngology-Head and Neck Surgery, CHL-Eich, Rue d’Eich 78, 1111 Luxembourg, Luxembourg;
| | - Giovanni Cammaroto
- Robotics Study Group of Young Otolaryngologists, International Federation of Oto-Rhino-Laryngological Societies, 75000 Paris, France; (C.C.E.); (N.F.); (L.A.V.); (G.C.); (M.R.B.); (G.I.); (M.M.-Y.); (A.M.S.); (R.B.); (J.M.-S.); (T.A.); (J.R.L.)
- Head-Neck, and Oral Surgery Unit, Department of Head-Neck Surgery, Otolaryngology, Morgagni Pierantoni Hospital, 47121 Forlì, Italy
| | - Maria Rosaria Barillari
- Robotics Study Group of Young Otolaryngologists, International Federation of Oto-Rhino-Laryngological Societies, 75000 Paris, France; (C.C.E.); (N.F.); (L.A.V.); (G.C.); (M.R.B.); (G.I.); (M.M.-Y.); (A.M.S.); (R.B.); (J.M.-S.); (T.A.); (J.R.L.)
- Department of Mental and Physical Health and Preventive Medicine, “L. Vanvitelli” University, 80121 Naples, Italy
| | - Giannicola Iannella
- Robotics Study Group of Young Otolaryngologists, International Federation of Oto-Rhino-Laryngological Societies, 75000 Paris, France; (C.C.E.); (N.F.); (L.A.V.); (G.C.); (M.R.B.); (G.I.); (M.M.-Y.); (A.M.S.); (R.B.); (J.M.-S.); (T.A.); (J.R.L.)
- Organi di Senso Department, Sapienza University of Rome, Viale del Policlinico 151, 00161 Rome, Italy
| | - Miguel Mayo-Yanez
- Robotics Study Group of Young Otolaryngologists, International Federation of Oto-Rhino-Laryngological Societies, 75000 Paris, France; (C.C.E.); (N.F.); (L.A.V.); (G.C.); (M.R.B.); (G.I.); (M.M.-Y.); (A.M.S.); (R.B.); (J.M.-S.); (T.A.); (J.R.L.)
- Otorhinolaryngology-Head and Neck Surgery Department, Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, 15001 Galicia, Spain
| | - Alberto Maria Saibene
- Robotics Study Group of Young Otolaryngologists, International Federation of Oto-Rhino-Laryngological Societies, 75000 Paris, France; (C.C.E.); (N.F.); (L.A.V.); (G.C.); (M.R.B.); (G.I.); (M.M.-Y.); (A.M.S.); (R.B.); (J.M.-S.); (T.A.); (J.R.L.)
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, 20121 Milan, Italy
| | - Robin Baudouin
- Robotics Study Group of Young Otolaryngologists, International Federation of Oto-Rhino-Laryngological Societies, 75000 Paris, France; (C.C.E.); (N.F.); (L.A.V.); (G.C.); (M.R.B.); (G.I.); (M.M.-Y.); (A.M.S.); (R.B.); (J.M.-S.); (T.A.); (J.R.L.)
- Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), 75000 Paris, France;
| | - Juan Maza-Solano
- Robotics Study Group of Young Otolaryngologists, International Federation of Oto-Rhino-Laryngological Societies, 75000 Paris, France; (C.C.E.); (N.F.); (L.A.V.); (G.C.); (M.R.B.); (G.I.); (M.M.-Y.); (A.M.S.); (R.B.); (J.M.-S.); (T.A.); (J.R.L.)
- Service of Otolaryngology, ENT Deparment, Virgen de la Macarena University Hospital,41000 Seville, Spain
| | - Abie H. Mendelsohn
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 94305, USA;
| | - Floyd Christopher Holsinger
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA;
| | - Fabio P. Ceccon
- Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Universidade Federal de São Paulo (UNIFESP), 06000 São Paulo, Brazil; (F.P.C.); (L.H.)
| | - Leonardo Haddad
- Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Universidade Federal de São Paulo (UNIFESP), 06000 São Paulo, Brazil; (F.P.C.); (L.H.)
| | - Stephane Hans
- Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), 75000 Paris, France;
| | - Ignazio La Mantia
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia” ENT Section, University of Catania, 95123 Catania, Italy; (I.L.M.); (S.C.); (F.G.)
| | - Salvatore Cocuzza
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia” ENT Section, University of Catania, 95123 Catania, Italy; (I.L.M.); (S.C.); (F.G.)
| | - Federica Gulinello
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia” ENT Section, University of Catania, 95123 Catania, Italy; (I.L.M.); (S.C.); (F.G.)
| | - Tareck Ayad
- Robotics Study Group of Young Otolaryngologists, International Federation of Oto-Rhino-Laryngological Societies, 75000 Paris, France; (C.C.E.); (N.F.); (L.A.V.); (G.C.); (M.R.B.); (G.I.); (M.M.-Y.); (A.M.S.); (R.B.); (J.M.-S.); (T.A.); (J.R.L.)
- Division of Otolaryngology-Head and Neck Surgery, Center Hospitalier de l’Université de Montréal, Head and Neck Deparment, Montreal, QC 54550, Canada
| | - Jerome R. Lechien
- Robotics Study Group of Young Otolaryngologists, International Federation of Oto-Rhino-Laryngological Societies, 75000 Paris, France; (C.C.E.); (N.F.); (L.A.V.); (G.C.); (M.R.B.); (G.I.); (M.M.-Y.); (A.M.S.); (R.B.); (J.M.-S.); (T.A.); (J.R.L.)
- Department of Otolaryngology and Head and Neck Surgery, Foch Hospital, Paris Saclay University, 75000 Paris, France
- Department of Otolaryngology and Head and Neck Surgery, Division of Broncho-Esophagology, EpiCURA Hospital, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), 7031 Mons, Belgium
- Department of Otolaryngology and Head and Neck Surgery, Elsan Polyclinic of Poitiers, 86000 Poitiers, France
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Yam C, DiMatteo A, Alnouri G, Sataloff RT. Otolaryngology resident familiarity with surgical instruments and preoperative setup: A pilot study. Am J Otolaryngol 2023; 44:103930. [PMID: 37229908 DOI: 10.1016/j.amjoto.2023.103930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 05/13/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVE This study was designed to determine otolaryngology (ORL) residents' ability to prepare the operating room independently for ORL surgical cases and their familiarity with ORL surgical instruments and related equipment. METHODS A 24-question, one-time, anonymous survey was distributed to otolaryngology-head and neck surgery program directors for distribution among their residents in the United States in November 2022. Residents in every post-graduate year were surveyed. Spearman's ranked correlation and Mann-Whitney U test were used. RESULTS The response rate among program directors was 9.5 % (11/116 programs), while the response rate among residents was 51.5 % (88/171 residents). A total of 88 survey responses were completed. 61 % of ORL residents who responded were able to name most instruments used in surgical cases. The most recognized surgical instruments by ORL residents were microdebrider (99 %) and alligator forceps (98 %); the least recognized were bellucci micro scissors (72 %) and pituitary forceps (52 %); and all instruments except the microdebrider showed significantly increased recognition with increasing post graduate training year (PGY), p ≤ 0.05. ORL residents were most able to set up independently the electrocautery (77 %) and laryngoscope suspension (73 %), while they were least able to set up the robot laser (6.8 %) and coblator (26 %) independently. All instruments showed significant positive correlations with increasing PGY; the strongest correlation was found in laryngoscope suspension, r = 0.74. 48 % of ORL residents reported that there were times when surgical techs and nurses were not available. Only 54 % of ORL residents reported being able to set up instruments when alone in the operating room, including 77.8 % of PGY-5 residents. Only 8 % of residents reported receiving education related to surgical instruments from their residency program, while 85 % thought that ORL residencies should have courses or educational materials about surgical instruments. CONCLUSION ORL residents' familiarity with surgical instruments and preoperative setup improved throughout their training. However, specific instruments had much lower recognition than others and a lower ability for independent setup. Nearly half of ORL residents reported being unable to set up surgical instruments in the absence of surgical staff. Implementation of surgical instrument education may improve these deficiencies.
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Affiliation(s)
- Christopher Yam
- Department of Otolaryngology-Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, PA, United States of America.
| | - Andrew DiMatteo
- Department of Otolaryngology, Tripler Army Medical Center, Honolulu, HI, United States of America.
| | - Ghiath Alnouri
- Department of Otolaryngology-Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, PA, United States of America.
| | - Robert T Sataloff
- Department of Otolaryngology - Head and Neck Surgery, Senior Associate Dean for Clinical Academic Specialties, Drexel University College of Medicine, United States of America; Otolaryngology and Communication Sciences Research, Lankenau Institute for Medical Research, United States of America.
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Mella MH, Chabrillac E, Dupret-Bories A, Mirallie M, Vergez S. Transoral Robotic Surgery for Head and Neck Cancer: Advances and Residual Knowledge Gaps. J Clin Med 2023; 12:jcm12062303. [PMID: 36983308 PMCID: PMC10056198 DOI: 10.3390/jcm12062303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 03/11/2023] [Accepted: 03/14/2023] [Indexed: 03/17/2023] Open
Abstract
Minimally invasive surgery is a growing field in surgical oncology. After acquiring its first Food and Drug Administration approval in 2009 for T1–T2 malignancies of the oral cavity, oropharynx, and larynx, transoral robotic surgery (TORS) has gained popularity thanks to its wristed instruments and magnified three-dimensional view, enhancing surgical comfort in remote-access areas. Its indications are expanding in the treatment of head and neck cancer, i.e., resection of tumors of the larynx, hypopharynx, or parapharyngeal space. However, this expansion must remain cautious and based on high-level evidence, in order to guarantee safety and oncological outcomes which are comparable to conventional approaches. This narrative review assesses the current role of TORS in head and neck cancer from an evidence-based perspective, and then identifies what knowledge gaps remain to be addressed.
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Affiliation(s)
- Mariam H. Mella
- Department of Otolaryngology, Head and Neck Surgery, Toulouse University Hospital—Larrey Hospital, 24 Chemin de Pouvourville, CEDEX 9, 31059 Toulouse, France
| | - Emilien Chabrillac
- Department of Surgery, University Cancer Institute of Toulouse—Oncopole, 31100 Toulouse, France
| | - Agnès Dupret-Bories
- Department of Otolaryngology, Head and Neck Surgery, Toulouse University Hospital—Larrey Hospital, 24 Chemin de Pouvourville, CEDEX 9, 31059 Toulouse, France
- Department of Surgery, University Cancer Institute of Toulouse—Oncopole, 31100 Toulouse, France
| | - Mathilde Mirallie
- Department of Otolaryngology, Head and Neck Surgery, Toulouse University Hospital—Larrey Hospital, 24 Chemin de Pouvourville, CEDEX 9, 31059 Toulouse, France
- Department of Surgery, University Cancer Institute of Toulouse—Oncopole, 31100 Toulouse, France
| | - Sébastien Vergez
- Department of Otolaryngology, Head and Neck Surgery, Toulouse University Hospital—Larrey Hospital, 24 Chemin de Pouvourville, CEDEX 9, 31059 Toulouse, France
- Department of Surgery, University Cancer Institute of Toulouse—Oncopole, 31100 Toulouse, France
- Correspondence: ; Tel.: +33-5-67-77-17-32
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Poupore NS, Chen T, Nguyen SA, Nathan CAO, Newman JG. Transoral Robotic Surgery for Oropharyngeal Squamous Cell Carcinoma of the Tonsil versus Base of Tongue: A Systematic Review and Meta-Analysis. Cancers (Basel) 2022; 14:cancers14153837. [PMID: 35954500 PMCID: PMC9367622 DOI: 10.3390/cancers14153837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/01/2022] [Accepted: 08/04/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Transoral Robotic Surgery (TORS) has become widely adopted for the surgical removal of oropharyngeal squamous cell carcinoma (OPSCC). However, it is currently unknown if TORS has equal efficacy and outcomes in patients with tonsillar or base of tongue (BOT) OPSCC. Therefore, we performed a systematic review, including articles describing the surgical management of OPSCC with TORS that compared margin status, complications, and recurrence between tonsil and BOT. BOT OPSCC had a higher rate of positive margins compared to tonsillar OPSCC. However, no differences were seen in the recurrence or postoperative hemorrhage rates of BOT and tonsillar OPSCC. While a higher rate of positive margins was seen in BOT OPSCC when compared to tonsillar OPSCC, this did not translate to a higher recurrence rate in the BOT group. Future research on which subset of patients with BOT is more likely to have positive margins is warranted to improve the utility of TORS further. Abstract Transoral Robotic Surgery (TORS) has become widely adopted for the surgical removal of oropharyngeal squamous cell carcinoma (OPSCC), with the most common locations being in the tonsil and base of tongue (BOT). However, it is currently unknown if TORS has equal efficacy and outcomes in patients with tonsillar or BOT OPSCC. Therefore, the aim of this study was to compare the margin status and recurrence rates of tonsillar and BOT OPSCC after TORS. Per PRISMA guidelines, PubMed, Scopus, and CINAHL were systematically searched from inception to 2/28/2022. Articles including the surgical management of OPSCC with TORS that compared margin status, complications, and recurrence between tonsil and BOT were included. Meta-analyses of proportions and odds ratios were performed. A total of 28 studies were included, comprising 1769 patients with tonsillar OPSCC and 1139 patients with BOT OPSCC. HPV positivity was seen in 92.3% of tumors. BOT OPSCC had a higher rate of positive margins compared to tonsillar OPSCC (28.1% [95%CI 15.1–43.3] vs. 7.5% [95%CI 3.3–13.3]). No differences were seen in recurrence between BOT and tonsillar OPSCC (OR 1.1 [95%CI 0.8–1.5], p = 0.480). In addition, no differences in postoperative hemorrhage were seen between tonsillar and BOT OPSCC (10.7% [95%CI 6.1–16.5] vs. 8.8% [95% CI 1.5–21.3]). While a higher rate of positive margins was seen in BOT OPSCC when compared to tonsil OPSCC, this did not translate to a higher recurrence rate in the BOT group. Future research on which subset of patients with BOT is more likely to have positive margins is warranted to improve the utility of TORS further.
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Affiliation(s)
- Nicolas S. Poupore
- Department of Otolaryngology—Head and Neck Surgery, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Tiffany Chen
- Department of Otolaryngology—Head and Neck Surgery, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Shaun A. Nguyen
- Department of Otolaryngology—Head and Neck Surgery, Medical University of South Carolina, Charleston, SC 29425, USA
- Correspondence:
| | - Cherie-Ann O. Nathan
- Department of Otolaryngology—Head and Neck Surgery, Louisiana State University Health Sciences Center, Shreveport, LA 71103, USA
| | - Jason G. Newman
- Department of Otolaryngology—Head and Neck Surgery, Medical University of South Carolina, Charleston, SC 29425, USA
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Murr AT, Lumley CJ, Feins RH, Hackman TG. Evaluation of a 3D-Printed Transoral Robotic Surgery Simulator Utilizing Artificial Tissue. Laryngoscope 2021; 132:1588-1593. [PMID: 34882806 PMCID: PMC9177903 DOI: 10.1002/lary.29981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 11/24/2021] [Accepted: 11/30/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS Transoral robotic surgery (TORS) poses challenges for operators in training, with limited robot access on a platform requiring distinct surgical skills. Few simulators exist, and current virtual reality training modules exclude head and neck simulations. This study evaluates the construct validity for a novel low-cost TORS simulator. STUDY DESIGN Single institution prospective observational study. METHODS Using 3D-printed oral cavity structures and replaceable artificial tissue components, a modular TORS simulator was constructed for short-duration hands-on simulations with the da Vinci SI robot. Sixteen surgeons of differing robotic skill levels, no experience (novice), prior experience, and formal robot training, participated in simulated tonsil and tongue base tumor resections. Video recordings of each participant were graded by a blinded robotically trained surgeon using a 35-point Global Evaluative Assessment of Robotic Surgery (GEARS) criterion adapted for the TORS simulator. RESULTS Operators reporting formal robotic training or prior robot experience achieved significantly higher mean total GEARS scores compared to novice operators (32 vs. 20.5; P < .001). Overall, mean total GEARS scores correlated with reported experience level; novice operators scored 54% of total points at 19 (4.5), operators with prior experience scored 82.3% of total points at 28.8 (2.6), and robotically trained operators scored 97.1% of total points at 34 (1.7). CONCLUSION With a GEARS criterion, our simulator successfully differentiated novice from experienced and robotically trained operators of the da Vinci SI robot during simulated tonsillectomy and base of tongue resections. These findings support the construct validity of this prototype simulator and offer a foundation for further testing of predictive validity. LEVEL OF EVIDENCE 2 Laryngoscope, 2021.
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Affiliation(s)
- Alexander T Murr
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Catherine J Lumley
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Richard H Feins
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Trevor G Hackman
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
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He B, de Smet MD, Sodhi M, Etminan M, Maberley D. A review of robotic surgical training: establishing a curriculum and credentialing process in ophthalmology. Eye (Lond) 2021; 35:3192-3201. [PMID: 34117390 PMCID: PMC8602368 DOI: 10.1038/s41433-021-01599-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 05/04/2021] [Accepted: 05/07/2021] [Indexed: 12/21/2022] Open
Abstract
Ophthalmic surgery requires a highly dexterous and precise surgical approach to work within the small confines of the eye, and the use of robotics offers numerous potential advantages to current surgical techniques. However, there is a lag in the development of a comprehensive training and credentialing system for robotic eye surgery, and certification of robotic skills proficiency relies heavily on industry leadership. We conducted a literature review on the curricular elements of established robotics training programs as well as privileging guidelines from various institutions to outline key components in training and credentialing robotic surgeons for ophthalmic surgeries. Based on our literature review and informal discussions between the authors and other robotic ophthalmic experts, we recommend that the overall training framework for robotic ophthalmic trainees proceeds in a stepwise, competency-based manner from didactic learning, to simulation exercises, to finally operative experiences. Nontechnical skills such as device troubleshooting and interprofessional teamwork should also be formally taught and evaluated. In addition, we have developed an assessment tool based on validated global rating scales for surgical skills that may be used to monitor the progress of trainees. Finally, we propose a graduating model for granting privileges to robotic surgeons. Further work will need to be undertaken to assess the feasibility, efficacy and integrity of the training curriculum and credentialing practices for robotic ophthalmic surgery.
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Affiliation(s)
- Bonnie He
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Marc D de Smet
- Department of Ophthalmology, University of Leiden, Leiden, Netherlands
| | - Mohit Sodhi
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Mahyar Etminan
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - David Maberley
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
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Lin HJ, Lin FCF, Yang TL, Chang CH, Kao CH, Tsai SCS. Cervical lymphatic malformations amenable to transhairline robotic surgical excision in children: A case series. Medicine (Baltimore) 2021; 100:e27200. [PMID: 34664849 PMCID: PMC8448076 DOI: 10.1097/md.0000000000027200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 08/25/2021] [Indexed: 11/25/2022] Open
Abstract
Lymphatic malformations are rare benign malformations that predominantly occur in the head and neck region. The advent of surgical robots in head and neck surgery may provide beneficial outcomes for pediatric patients. Here, we describe our experiences with transhairline incisions for robot-assisted surgical resection of cervical lymphatic malformations in pediatric patients.In this prospective longitudinal cohort study, we recruited consecutive patients under 18 years of age who were diagnosed with congenital cervical lymphatic malformations and scheduled for transhairline approach robotic surgery at a single medical center. We documented the docking times, console times, surgical results, complications, and postoperative follow-up outcomes.The studied patients included 2 with mixed-type lymphatic malformations and 2 with macrocystic-type lymphatic malformations. In all 4 patients, the incision was hidden in the hairline; the incision length was <5 cm in 3 patients but was extended to 6 cm in 1 patient. Elevating the skin flap and securely positioning it with Yang retractor took <1 hour in all cases. The mean docking time was 5.5 minutes, and the mean console time was 1 hour and 46 minutes. All 4 surgeries were completed endoscopically with the robot. The average total drainage volume in the postoperative period was 21.75 mL. No patients required tracheotomy or nasogastric feeding tubes. Neither were adverse surgery-associated neurovascular sequelae observed. All 4 patients were successfully treated for their lymphatic malformations, primarily with robotic surgical excisions.Cervical lymphatic malformations in pediatric patients could be accessed, properly visualized, and safely resected with transhairline-approach robotic surgery. Transhairline-approach robotic surgery is an innovative method for meeting clinical needs and addressing esthetic concerns.
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Affiliation(s)
- Han-Jie Lin
- Department of Otolaryngology, Tungs’ Taichung MetroHarbor Hospital, Taichung, Taiwan, Republic of China
| | - Frank Cheau-Feng Lin
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan, Republic of China
| | - Tsung-Lin Yang
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan, Republic of China
- College of Medicine, National Taiwan University, Taipei, Taiwan, Republic of China
| | - Chun-Hsiang Chang
- Department of Otolaryngology, Tungs’ Taichung MetroHarbor Hospital, Taichung, Taiwan, Republic of China
| | - Chia-Hui Kao
- Department of Pediatrics, Tungs’ Taichung MetroHarbor Hospital, Taichung, Taiwan, Republic of China
| | - Stella Chin-Shaw Tsai
- Department of Otolaryngology, Tungs’ Taichung MetroHarbor Hospital, Taichung, Taiwan, Republic of China
- Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan, Republic of China
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8
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Cheraghlou S, Christensen SR, Leffell DJ, Girardi M. Association of Treatment Facility Characteristics With Overall Survival After Mohs Micrographic Surgery for T1a-T2a Invasive Melanoma. JAMA Dermatol 2021; 157:531-539. [PMID: 33787836 DOI: 10.1001/jamadermatol.2021.0023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance Early-stage melanoma, among the most common cancers in the US, is typically treated with wide local excision. However, recent advances in immunohistochemistry have led to an increasing number of these cases being excised via Mohs micrographic surgery (MMS). Although studies of resections for other cancers have reported that facility-level factors are associated with patient outcomes, it is not yet established how these factors may affect outcomes for patients treated with Mohs micrographic surgery. Objective To evaluate the association of treatment center academic affiliation and case volume with long-term patient survival after MMS for T1a-T2a invasive melanoma. Design, Setting, and Participants In a retrospective cohort study, 4062 adults with nonmetastatic, T1a-T2a melanoma diagnosed from 2004 to 2014 and treated with MMS in the National Cancer Database (NCDB) were identified. The NCDB includes all reportable cases from Commission on Cancer-accredited facilities and is estimated to capture approximately 50% of all incident melanomas in the US. Multivariable survival analyses were conducted using Cox proportional hazards models. Data analysis was conducted from February 27 to August 18, 2020. Exposures Treatment facility characteristics. Main Outcomes and Measures Overall survival. Results The study population included 4062 patients (2213 [54.5%] men; median [SD] age, 60 [16.3] years) treated at 462 centers. Sixty-two centers were top decile-volume facilities (TDVFs), which treated 1757 patients (61.9%). Most TDVFs were academic institutions (37 of 62 [59.7%]). On multivariable analysis, treatment at an academic center was associated with a nearly 30% reduction in hazard of death (hazard ratio, 0.730; 95% CI, 0.596-0.895). In a separate analysis, treatment at TDVFs was also associated with improved survival (hazard ratio, 0.795; 95% CI, 0.648-0.977). Conclusions and Relevance In this cohort study, treatment of patients with T1a-T2a invasive melanoma excised with MMS at academic and top decile-volume (≥8 cases per year) facilities was associated with improved long-term survival compared with those excised by MMS at nonacademic and low-volume facilities. Identification and protocolization of the practices of these facilities may help to reduce survival differences between centers.
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Affiliation(s)
- Shayan Cheraghlou
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Sean R Christensen
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - David J Leffell
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Michael Girardi
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
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9
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Abstract
Technological developments have disrupted the practice of medicine throughout history. Endoscopic and robotic techniques in head and neck surgery have emerged over the past half-century and have been incrementally adapted to expanding indications within otolaryngology. Robotic and endoscopic surgery have an established role in treatment of oropharyngeal and laryngeal cancers, reducing surgical morbidity and improving survival relative to traditional open approaches. Surgical treatment of human papillomavirus-mediated oropharyngeal cancer via transoral robotic surgery offers equivalent oncologic and functional outcomes relative to radiotherapy. Newer iterations of single-port robotic systems continue to expand the scope of robotics in head and neck surgery.
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10
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Bessen SY, Wu X, Sramek MT, Shi Y, Pastel D, Halter R, Paydarfar JA. Image-guided surgery in otolaryngology: A review of current applications and future directions in head and neck surgery. Head Neck 2021; 43:2534-2553. [PMID: 34032338 DOI: 10.1002/hed.26743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 02/20/2021] [Accepted: 05/04/2021] [Indexed: 02/06/2023] Open
Abstract
Image-guided surgery (IGS) has become a widely adopted technology in otolaryngology. Since its introduction nearly three decades ago, IGS technology has developed rapidly and improved real-time intraoperative visualization for a diverse array of clinical indications. As usability, accessibility, and clinical experiences with IGS increase, its potential applications as an adjunct in many surgical procedures continue to expand. Here, we describe the basic components of IGS and review both the current state and future directions of IGS in otolaryngology, with attention to current challenges to its application in surgery of the nonrigid upper aerodigestive tract.
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Affiliation(s)
- Sarah Y Bessen
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Xiaotian Wu
- Massachussetts General Hospital, Boston, Massachusetts, USA
| | - Michael T Sramek
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Yuan Shi
- Thayer School of Engineering at Dartmouth, Hanover, New Hampshire, USA
| | - David Pastel
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.,Department of Otolaryngology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.,Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Ryan Halter
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.,Thayer School of Engineering at Dartmouth, Hanover, New Hampshire, USA
| | - Joseph A Paydarfar
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.,Thayer School of Engineering at Dartmouth, Hanover, New Hampshire, USA.,Department of Otolaryngology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
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11
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McCrary HC, McLean SR, Luman A, O'Sullivan P, Smith B, Cannon RB. A National Survey of Robotic Surgery Training Among Otolaryngology-Head and Neck Surgery Residents. Ann Otol Rhinol Laryngol 2021; 130:1085-1092. [PMID: 33615826 DOI: 10.1177/0003489421996968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of this study is to describe the current state of robotic surgery training among Otolaryngology-Head and Neck Surgery (OHNS) residency programs in the United States. METHODS This is a national survey study among OHNS residents. All OHNS residency programs were identified via the Accreditation Council for Graduate Medical Education website. A total of 64/127 (50.3%) of OHNS programs were selected based on a random number generator. The main outcome measure was the number of OHNS residents with access to robotic surgery training and assessment of operative experience in robotic surgery among those residents. RESULTS A total of 140 OHNS residents participated in the survey, of which 59.3% (n = 83) were male. Response rate was 40.2%. Respondents came from middle 50.0% (n = 70), southern 17.8% (n = 25), western 17.8% (n = 25), and eastern sections 14.3% (n = 20). Most respondents (94.3%, n = 132) reported that their institution utilized a robot for head and neck surgery. Resident experience at the bedside increased in the junior years of training and console experience increased across the years particularly for more senior residents. However, 63.4% of residents reported no operative experience at the console. Only 11.4% of programs have a structured robotics training program. CONCLUSION This survey indicated that nearly all OHNS residencies utilize robotic surgery in their clinical practice with residents receiving little formal education in robotics or experience at the console. OHNS residencies should aim to increase access to training opportunities in order to increase resident competency. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Hilary C McCrary
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Utah Health Sciences Center, Salt Lake City, UT, USA
| | - Sierra R McLean
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Abigail Luman
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Patricia O'Sullivan
- University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Brigitte Smith
- Department of Surgery, Division of Vascular Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Richard B Cannon
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Utah Health Sciences Center, Salt Lake City, UT, USA
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12
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Mendelsohn AH, Kim C, Song J, Singh A, Le T, Abiri A, Berke GS, Geoghegan R. Transoral Robotic Surgical Proficiency Via Real-Time Tactile Collision Awareness System. Laryngoscope 2020; 130 Suppl 6:S1-S17. [PMID: 32865822 DOI: 10.1002/lary.29034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/27/2020] [Accepted: 07/30/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVES In 2009, the Food and Drug Administration approved the use of the surgical robotic system for removal of benign and malignant conditions of the upper aerodigestive tract. This novel application of robotic-assisted surgery, termed transoral robotic surgery (TORS), places robotic instruments and camera system through the mouth to reach recessed areas of the pharynx and larynx. Over the successive decade, there was a rapid adoption of TORS with a surgical growth rate that continues to increase. Despite the rapid clinical acceptance, the field of TORS has not yet seen substantive changes or advances in the technical shortcomings, the lack of which has restricted objective TORS-specific surgical skills assessment as well as subsequent skills improvement efforts. One of the primary technical challenges of TORS is operating in a confined space, where the robotic system is maneuvered within the restrictive boundaries of the mouth and throat. Due to these confined boundaries of the pharynx, instruments can frequently collide with anatomic structures such as teeth and bone, producing anatomic collisions. Therefore, we hypothesized that anatomic collisions negatively impact TORS surgical performance. Secondarily, we hypothesized that avoidance of unwanted anatomic collisions could improve TORS surgical proficiency. METHODS Design and fidelity testing for a custom TORS training platform with an integrated anatomic collision-sensing system providing real-time tactile feedback is described. Following successful platform assembly and testing, validation study using the platform was carried through prospective surgical training with trial randomization. Twenty otolaryngology-head and neck surgery residents, each trainee performing three discrete mock surgical trials (n = 60), performed the initial system validation. Ten of the 20 residents were randomized to perform the surgical trials utilizing the real-time feedback system. The remaining 10 residents were randomized to perform the surgical trials without the feedback system, although the system still could record collision data. Surgical proficiency was measured by Global Evaluative Assessment of Robotic Skills (GEARS) score, time to completion, and tumor resection scores (categorical scale ranging 0-3, describing the adequacy of resection). RESULTS Major anatomic collisions (greater than 5N of force) negatively affected GEARS robotic skills. A mixed model analysis demonstrated that for every additional occurrence of a major collision, GEARS robotic skills assessment score would decrease by 0.29 points (P = .04). Real-time collision awareness created significantly fewer major (> 5 N) anatomic collisions with the tactile feedback system active (n = 30, mean collisions = 2.9 ± 4.2) as compared with trials without tactile feedback (n = 30, mean collisions = 12.53 ± 23.23) (P < .001). The second assessment measure of time to completion was unaffected by the presence of collisions or by the use of tactile feedback system. The third proficiency assessment was measured with tumor resection grading. Tumor resection scores was significantly (P = .02) improved with collision awareness system activated than trials without collision awareness. CONCLUSION In order to test our primary hypothesis, a novel TORS training platform was successfully developed that provides collision force measurements including frequency, severity, and duration of anatomic collisions. Additionally, the platform was modulated to provide real-time tactile feedback of the occurrence of out-of-field collisions. Utilizing this custom platform, our hypothesis that anatomic collisions during TORS diminishes surgical performance was supported. Additionally, our secondary hypothesis that subsequent reduction of anatomic collisions improves TORS proficiency was supported by the surgical trial. Dedicated investigation to characterize the effect size and clinical impact is required in order to translate this finding into training curriculums and into clinical utilization. LEVEL OF EVIDENCE II (Randomized trial) Laryngoscope, 130:S1-S17, 2020.
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Affiliation(s)
- Abie H Mendelsohn
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, U.S.A.,Department of Surgery, Center for Advanced Surgical and Interventional Technology, David Geffen School of Medicine, Los Angeles, California, U.S.A
| | - Christine Kim
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, U.S.A
| | - Jonathan Song
- Department of Surgery, Center for Advanced Surgical and Interventional Technology, David Geffen School of Medicine, Los Angeles, California, U.S.A
| | - Aadesh Singh
- Department of Surgery, Center for Advanced Surgical and Interventional Technology, David Geffen School of Medicine, Los Angeles, California, U.S.A
| | - Tyler Le
- Department of Surgery, Center for Advanced Surgical and Interventional Technology, David Geffen School of Medicine, Los Angeles, California, U.S.A
| | - Ahmad Abiri
- Department of Surgery, Center for Advanced Surgical and Interventional Technology, David Geffen School of Medicine, Los Angeles, California, U.S.A
| | - Gerald S Berke
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, U.S.A
| | - Rory Geoghegan
- Department of Surgery, Center for Advanced Surgical and Interventional Technology, David Geffen School of Medicine, Los Angeles, California, U.S.A
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13
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Malpani A, Vedula SS, Lin HC, Hager GD, Taylor RH. Effect of real-time virtual reality-based teaching cues on learning needle passing for robot-assisted minimally invasive surgery: a randomized controlled trial. Int J Comput Assist Radiol Surg 2020; 15:1187-1194. [DOI: 10.1007/s11548-020-02156-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 04/03/2020] [Indexed: 01/30/2023]
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14
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Razavi CR, Tanavde V, Shaear M, Richmon JD, Russell JO. Simulations and simulators in head and neck endocrine surgery. ACTA ACUST UNITED AC 2020; 5. [PMID: 32395699 DOI: 10.21037/aot.2020.03.03] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Simulations and simulators have become an increasingly important tool in trainee education across many surgical disciplines, particularly for robotic and minimally invasive procedures. Thyroidectomy and parathyroidectomy are common procedures performed across multiple surgical disciplines, however, there is limited literature regarding training models/simulators for these operations. This is despite the advent and growing popularity of remote-access thyroidectomy techniques, where simulators may provide significant value in trainee education and safe implementation. Here we review the literature regarding available simulations/simulators in head and neck endocrine surgery for both conventional transcervical approaches and newer remote-access thyroidectomy techniques.
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Affiliation(s)
- Christopher R Razavi
- Division of Head & Neck Endocrine Surgery, Department of Otolaryngology, Head & Neck Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Ved Tanavde
- Division of Head & Neck Endocrine Surgery, Department of Otolaryngology, Head & Neck Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Mohammad Shaear
- Division of Head & Neck Endocrine Surgery, Department of Otolaryngology, Head & Neck Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Jeremy D Richmon
- Department of Otolaryngology, Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, USA
| | - Jonathon O Russell
- Division of Head & Neck Endocrine Surgery, Department of Otolaryngology, Head & Neck Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
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15
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Affiliation(s)
- Christopher J. Miller
- Penn Dermatology Oncology Center, Hospital of the University of Pennsylvania, Philadelphia
| | - Cerrene N. Giordano
- Department of Dermatology, Mount Sinai Icahn School of Medicine, New York, New York
| | - H. William Higgins
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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16
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Rathi VK, Scangas GA, Gray ST. Off-label Treatment in Otolaryngology-A Cautionary Tale. JAMA Otolaryngol Head Neck Surg 2019; 145:399-400. [PMID: 30946446 DOI: 10.1001/jamaoto.2019.0150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Vinay K Rathi
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts.,Harvard Business School, Boston, Massachusetts
| | - George A Scangas
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
| | - Stacey T Gray
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
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17
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Yang T, Li H, Holsinger FC, Koh YW. Submandibular gland resection via the trans‐hairline approach: A preclinical study of a novel flexible single‐port surgical system and the surgical experiences of standard multiarm robotic surgical systems. Head Neck 2019; 41:2231-2238. [DOI: 10.1002/hed.25692] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 12/04/2018] [Accepted: 01/15/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
- Tsung‐Lin Yang
- Department of OtolaryngologyNational Taiwan University Hospital and College of Medicine Taipei Taiwan
- Graduate Institute of Clinical MedicineCollege of Medicine, National Taiwan University Taipei Taiwan
- Research Center for Developmental Biology and Regenerative MedicineNational Taiwan University Taipei Taiwan
| | - Hong Li
- Yale University School of Medicine New Haven Connecticut
| | | | - Yoon Woo Koh
- Department of OtorhinolaryngologyYonsei University College of Medicine Seoul Republic of Korea
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18
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Robotic Thoracic Surgery Training for Residency Programs. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2018; 13:417-422. [DOI: 10.1097/imi.0000000000000573] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objective Robotic-assisted surgery is increasingly being used in thoracic surgery. Currently, the Integrated Thoracic Surgery Residency Program lacks a standardized curriculum or requirement for training residents in robotic-assisted thoracic surgery. In most circumstances, because of the lack of formal residency training in robotic surgery, hospitals are requiring additional training, mentorship, and formal proctoring of cases before granting credentials to perform robotic-assisted surgery. Therefore, there is necessity for residents in Integrated Thoracic Surgery Residency Program to have early exposure and formal training on the robotic platform. We propose a curriculum that can be incorporated into such programs that would satisfy both training needs and hospital credential requirements. Methods We surveyed all 26 Integrated Thoracic Surgery Residency Program Directors in the United States. We also performed a PubMed literature search using the key word “robotic surgery training curriculum.” We reviewed various robotic surgery training curricula and evaluation tools used by urology, obstetrics gynecology, and general surgery training programs. We then designed a proposed curriculum geared toward thoracic Integrated Thoracic Surgery Residency Program adopted from our credentialing experience, literature review, and survey consensus. Results Of the 26 programs surveyed, we received 17 responses. Most Integrated Thoracic Surgery Residency Program directors believe that it is important to introduce robotic surgery training during residency. Our proposed curriculum is integrated during postgraduate years 2 to 6. In the preclinical stage postgraduate years 2 to 3, residents are required to complete introductory online modules, virtual reality simulator training, and in-house workshops. During clinical stage (postgraduate years 4–6), the resident will serve as a supervised bedside assistant and progress to a console surgeon. Each case will have defined steps that the resident must demonstrate competency. Evaluation will be based on standardized guidelines. Conclusions Expansion and utilization of robotic assistance in thoracic surgery have increased. Our proposed curriculum aims to enable Integrated Thoracic Surgery Residency Program residents to achieve competency in robotic-assisted thoracic surgery and to facilitate the acquirement of hospital privileges when they enter practice.
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19
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Plonowska KA, Ha PK, Ryan WR. Advanced head and neck surgical techniques: A survey of US otolaryngology resident perspectives. Auris Nasus Larynx 2018; 46:272-278. [PMID: 30170906 DOI: 10.1016/j.anl.2018.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 08/01/2018] [Accepted: 08/12/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To assess the perspectives of OHNS residents with regards to their training in the following advanced head and neck surgery techniques: transoral robotic surgery (TORS), transoral laser microsurgery (TLM), sialendoscopy, and surgeon-performed ultrasound (SP-US) for possible curricula development. METHODS Cross-sectional survey. A 20-item questionnaire was electronically distributed to OHNS residency programs assessing volume of cases, training barriers, satisfaction, additional training preferences, and pertinence to future practice. RESULTS One hundred thirty-one residents completed the questionnaire. Trainee satisfaction with advanced techniques did not vary significantly with level of training (PGY) or intent to pursue fellowship. Residents who participated in more TLM, sialendoscopy, and SP-US cases were significantly more likely to be satisfied with their training (all p<0.05). The most frequently reported limitation to training was low home institution procedure volume. Seventy-eight of 123 respondents (63.4%) indicated insufficient opportunity to participate in TORS, with most residents reporting that TORS was preferentially performed by attendings (59/78, 75.6%). Forty-five of 126 (35.7%) reported having adequate access to skills training in TORS, compared to 43.6%, 48.4%, and 54.8% for sialendoscopy, TLM, and SP-US, respectively. A vast majority expressed interest in home institution-sponsored training courses in SP-US (120/127, 94.5%) and sialendoscopy (105/129, 81.4%). Many anticipated using SP-US (63.3%) and sialendoscopy (49.6%) in their future practices. CONCLUSION Greater resident participation in advanced head and neck surgical procedures is associated with higher trainee satisfaction. There is a possible need for additional home institution-sponsored training courses, especially in sialendoscopy and SP-US. LEVEL OF EVIDENCE N/A.
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Affiliation(s)
- Karolina A Plonowska
- University of California-San Francisco School of Medicine, San Francisco, CA, United States
| | - Patrick K Ha
- Division of Head and Neck Oncologic and Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, CA, United States
| | - William R Ryan
- Division of Head and Neck Oncologic and Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, CA, United States.
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20
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Krishnan G, Mintz J, Foreman A, Hodge JC, Krishnan S. The acceptance and adoption of transoral robotic surgery in Australia and New Zealand. J Robot Surg 2018; 13:301-307. [DOI: 10.1007/s11701-018-0856-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 07/23/2018] [Indexed: 10/28/2022]
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21
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Shay SG, Chrin JD, Wang MB, Mendelsohn AH. Initial and Long-term Retention of Robotic Technical Skills in an Otolaryngology Residency Program. Laryngoscope 2018; 129:1380-1385. [PMID: 30098045 DOI: 10.1002/lary.27425] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 05/21/2018] [Accepted: 06/11/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS To objectively assess the initial and long-term retention of robotic surgical skills of otolaryngology residents. STUDY DESIGN This study was performed in an academic otolaryngology residency training program. Between October 2015 and November 2016, residents were invited to complete a prospective, multiphase robotic surgical skills training course: 1) online da Vinci Surgical System Assessment and didactic, 2) faculty-supervised robotic simulator training, 3) robotic docking and draping training, 4) robotic dry-lab exercises. To optimize surgical skill retention, the training laboratory was repeated 2 weeks after the initial training session. METHODS Twenty otolaryngology residents were included. Primary outcome was measured as robotic skill assessment scores on three tasks: camera targeting, peg board, and needle targeting. Skill assessments were completed prior to training, between the two training sessions, and at 1 month and 6 months after training. Residents were also asked to complete a self-assessment questionnaire. RESULTS Camera targeting scores were improved at midtraining (P < .001) and 1-month posttraining (P = .010). Peg board scores were improved at 1 month training (P = .043). Needle targeting scores were improved at midtraining (P = .002), 1 month (P = .002), and 6 months posttraining (P < .001). Resident self-assessment scores demonstrating comfort with using the robotic console (P < .01) and docking/draping (P < .01) improved significantly following the training. CONCLUSIONS Following a multiphase robotic training program, otolaryngology residents demonstrated significant, objective skill acquisition and retention at 1 month and 6 months follow-up. Although the proposed training strategy may be considered an important step in otolaryngology residency training, additional innovations are being designed toward a formal robotic training curriculum. LEVEL OF EVIDENCE NA Laryngoscope, 129:1380-1385, 2019.
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Affiliation(s)
- Sophie G Shay
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann and Robert Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jonathan D Chrin
- Center for Advanced Surgical and Interventional Technology, David Geffen School of Medicine, Ronald Reagan Medical Center, University of California Los Angeles, Los Angeles, California
| | - Marilene B Wang
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Abie H Mendelsohn
- Center for Advanced Surgical and Interventional Technology, David Geffen School of Medicine, Ronald Reagan Medical Center, University of California Los Angeles, Los Angeles, California.,Department of Head and Neck Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
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22
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Song G, Hou C, Zhao Y, Zhao X, Han J. Mechanical Design and Control Method of a Hollow Modular Joint for Minimally Invasive Spinal Surgery. INT J HUM ROBOT 2018. [DOI: 10.1142/s0219843618500172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Design of the hollow modular joint plays an important role in modern robot layout, fixation, and wiring. In this paper, a hollow modular joint that meets the requirement of a minimally invasive surgical robot is proposed. The mechanical and control design is sequentially illustrated, and the torque sensor and its optimization are provided. Furthermore, a free-force control method is introduced. To analyze the designed module, the simulation of the redundant robot, comprised of the designed joint in seven degrees of freedom, is presented. The results of analyses showed that the designed hollow modular joint is valid and effective.
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Affiliation(s)
- Guoli Song
- State Key Laboratory of Robotics, Shenyang Institute of Automation, Chinese Academy of Sciences, Shenyang 110016, P. R. China
| | - Che Hou
- State Key Laboratory of Robotics, Shenyang Institute of Automation, Chinese Academy of Sciences, Shenyang 110016, P. R. China
- University of Chinese Academy of Sciences, Beijing 100049, P. R. China
| | - Yiwen Zhao
- State Key Laboratory of Robotics, Shenyang Institute of Automation, Chinese Academy of Sciences, Shenyang 110016, P. R. China
| | - Xingang Zhao
- State Key Laboratory of Robotics, Shenyang Institute of Automation, Chinese Academy of Sciences, Shenyang 110016, P. R. China
| | - Jianda Han
- State Key Laboratory of Robotics, Shenyang Institute of Automation, Chinese Academy of Sciences, Shenyang 110016, P. R. China
- Institute of Robotics and Automatic Information System, Nankai University, Tianjin 300071, P. R. China
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23
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Fastenberg JH, Gibber MJ, Smith RV. Introductory TORS training in an otolaryngology residency program. J Robot Surg 2018; 12:617-623. [DOI: 10.1007/s11701-018-0784-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 01/28/2018] [Indexed: 11/29/2022]
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Persky MJ, Albergotti WG, Rath TJ, Kubik MW, Abberbock S, Geltzeiler M, Kim S, Duvvuri U, Ferris RL. Positive Margins by Oropharyngeal Subsite in Transoral Robotic Surgery for T1/T2 Squamous Cell Carcinoma. Otolaryngol Head Neck Surg 2017; 158:660-666. [PMID: 29182490 DOI: 10.1177/0194599817742852] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Objective To compare positive margin rates between the 2 most common subsites of oropharyngeal transoral robotic surgery (TORS), the base of tongue (BOT) and the tonsil, as well as identify preoperative imaging characteristics that predispose toward positive margins. Study Design Case series with chart review. Setting Tertiary care referral center. Subjects and Methods We compared the final and intraoperative positive margin rate between TORS resections for tonsil and BOT oropharyngeal squamous cell carcinoma (OPSCC), as well as the effect of margins on treatment. A blinded neuroradiologist examined the preoperative imaging of BOT tumors to measure their dimensions and patterns of spread and provided a prediction of final margin results. Results Between January 2010 and May 2016, a total of 254 patients underwent TORS for OPSCC. A total of 140 patients who underwent TORS for T1/T2 OPSCC met inclusion criteria. A final positive margin is significantly more likely for BOT tumors than tonsil tumors (19.6% vs 4.5%, respectively, P = .004) and likewise for intraoperative margins of BOT and tonsil tumors (35.3% vs 12.4%, respectively; P = .002). A positive final margin is 10 times more likely to receive chemoradiation compared to a negative margin, controlling for extracapsular spread and nodal status (odds ratio, 9.6; 95% confidence interval, 1.6-59.6; P = .02). Preoperative imaging characteristics and subjective radiologic examination of BOT tumors did not correlate with final margin status. Conclusion Positive margins are significantly more likely during TORS BOT resections compared to tonsil resections. More research is needed to help surgeons predict which T1/T2 tumors will be difficult to completely extirpate.
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Affiliation(s)
- Michael J Persky
- 1 Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York, USA
| | - William G Albergotti
- 2 Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Tanya J Rath
- 3 Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Mark W Kubik
- 2 Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Shira Abberbock
- 4 Biostatistics Facility, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| | - Mathew Geltzeiler
- 2 Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Seungwon Kim
- 2 Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Umamaheswar Duvvuri
- 2 Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Robert L Ferris
- 2 Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Albergotti WG, Gooding WE, Kubik MW, Geltzeiler M, Kim S, Duvvuri U, Ferris RL. Assessment of Surgical Learning Curves in Transoral Robotic Surgery for Squamous Cell Carcinoma of the Oropharynx. JAMA Otolaryngol Head Neck Surg 2017; 143:542-548. [PMID: 28196200 DOI: 10.1001/jamaoto.2016.4132] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Transoral robotic surgery (TORS) is increasingly employed as a treatment option for squamous cell carcinoma of the oropharynx (OPSCC). Measures of surgical learning curves are needed particularly as clinical trials using this technology continue to evolve. Objective To assess learning curves for the oncologic TORS surgeon and to identify the number of cases needed to identify the learning phase. Design, Setting, and Participants A retrospective review of all patients who underwent TORS for OPSCC at the University of Pittsburgh Medical Center between March 2010 and March 2016. Cases were excluded for involvement of a subsite outside of the oropharynx, for nonmalignant abnormality or nonsquamous histology, unknown primary, no tumor in the main specimen, free flap reconstruction, and for an inability to define margin status. Exposures Transoral robotic surgery for OPSCC. Main Outcomes and Measures Primary learning measures defined by the authors include the initial and final margin status and time to resection of main surgical specimen. A cumulative sum learning curve was developed for each surgeon for each of the study variables. The inflection point of each surgeon's curve was considered to be the point signaling the completion of the learning phase. Results There were 382 transoral robotic procedures identified. Of 382 cases, 160 met our inclusion criteria: 68 for surgeon A, 37 for surgeon B, and 55 for surgeon C. Of the 160 included patients, 125 were men and 35 were women. The mean (SD) age of participants was 59.4 (9.5) years. Mean (SD) time to resection including robot set-up was 79 (36) minutes. The inflection points for the final margin status learning curves were 27 cases (surgeon A) and 25 cases (surgeon C). There was no inflection point for surgeon B for final margin status. Inflection points for mean time to resection were: 39 cases (surgeon A), 30 cases (surgeon B), and 27 cases (surgeon C). Conclusions and Relevance Using metrics of positive margin rate and time to resection of the main surgical specimen, the learning curve for TORS for OPSCC is surgeon-specific. Inflection points for most learning curves peak between 20 and 30 cases.
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Affiliation(s)
- William G Albergotti
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - William E Gooding
- Biostatistics Facility, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - Mark W Kubik
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Mathew Geltzeiler
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Seungwon Kim
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Umamaheswar Duvvuri
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania3Veterans Affairs Pittsburgh Health System, Pittsburgh, Pennsylvania
| | - Robert L Ferris
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Controversies in Postoperative Irradiation of Oropharyngeal Cancer After Transoral Surgery. Surg Oncol Clin N Am 2017; 26:357-370. [DOI: 10.1016/j.soc.2017.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Gorphe P, Von Tan J, El Bedoui S, Hartl DM, Auperin A, Qassemyar Q, Moya-Plana A, Janot F, Julieron M, Temam S. Early assessment of feasibility and technical specificities of transoral robotic surgery using the da Vinci Xi. J Robot Surg 2017; 11:455-461. [PMID: 28064382 DOI: 10.1007/s11701-017-0679-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 01/02/2017] [Indexed: 11/26/2022]
Abstract
The latest generation Da Vinci® Xi™ Surgical System Robot released has not been evaluated to date in transoral surgery for head and neck cancers. We report here the 1-year results of a non-randomized phase II multicentric prospective trial aimed at assessing its feasibility and technical specificities. Our primary objective was to evaluate the feasibility of transoral robotic surgery using the da Vinci® Xi™ Surgical System Robot. The secondary objective was to assess peroperative outcomes. Twenty-seven patients, mean age 62.7 years, were included between May 2015 and June 2016 with tumors affecting the following sites: oropharynx (n = 21), larynx (n = 4), hypopharynx (n = 1), parapharyngeal space (n = 1). Eighteen patients were included for primary treatment, three for a local recurrence, and six for cancer in a previously irradiated field. Three were reconstructed with a FAMM flap and 6 with a free ALT flap. The mean docking time was 12 min. "Chopsticking" of surgical instruments was very rare. During hospitalization following surgery, 3 patients experienced significant bleeding between day 8 and 9 that required surgical transoral hemostasis (n = 1) or endovascular embolization (n = 2). Transoral robotic surgery using the da Vinci® Xi™ Surgical System Robot proved feasible with technological improvements compared to previous generation surgical system robots and with a similar postoperative course. Further technological progress is expected to be of significant benefit to the patients.
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Affiliation(s)
- Philippe Gorphe
- Department of Head and Neck Oncology, Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif, France.
| | - Jean Von Tan
- Department of Head and Neck Oncology, Oscar Lambret, Lille, France
| | - Sophie El Bedoui
- Department of Head and Neck Oncology, Oscar Lambret, Lille, France
| | - Dana M Hartl
- Department of Head and Neck Oncology, Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif, France
| | - Anne Auperin
- Department of Head and Neck Oncology, Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif, France
| | - Quentin Qassemyar
- Department of Head and Neck Oncology, Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif, France
| | - Antoine Moya-Plana
- Department of Head and Neck Oncology, Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif, France
| | - François Janot
- Department of Head and Neck Oncology, Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif, France
| | - Morbize Julieron
- Department of Head and Neck Oncology, Oscar Lambret, Lille, France
| | - Stephane Temam
- Department of Head and Neck Oncology, Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif, France
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Dietz A, Wichmann G, Wiegand S. Should We De-escalate the Treatment for HPV-Positive Tumors? Recent Results Cancer Res 2017; 206:173-181. [PMID: 27699538 DOI: 10.1007/978-3-319-43580-0_13] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
De-escalation or de-intensification of therapy is discussed since many retrospective analyses of former trials demonstrated significantly better outcome for patients suffering from p16/HPV16-positive oropharyngeal squamous cell carcinoma of head and neck (OHNSCC). These observations are comprehensively addressed, but the reader has to keep in mind that none of the currently discussed data result from prospective controlled trials addressing the HPV-discrimination in the primary endpoint design. Identification of the true HPV16-related tumors is still challenging and in addition with different clinical reports and lack of data of prospective trials not mature for routine clinical decision making in 2016. Independent of the currently lacking evidence for HPV-dependent treatment de-escalation, there are some relevant arguments to address this question in ongoing and future trials.
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Affiliation(s)
- Andreas Dietz
- Klinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde, Department Kopf- und Zahnmedizin, Universitätsklinikum Leipzig, Leipzig, Germany.
- Clinic of Otolaryngology, Head and Neck Surgery, Department of Head Medicine and Oral Health, University of Leipzig, Leipzig, Germany.
| | - Gunnar Wichmann
- Klinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde, Department Kopf- und Zahnmedizin, Universitätsklinikum Leipzig, Leipzig, Germany
- Clinic of Otolaryngology, Head and Neck Surgery, Department of Head Medicine and Oral Health, University of Leipzig, Leipzig, Germany
| | - Susanne Wiegand
- Klinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde, Department Kopf- und Zahnmedizin, Universitätsklinikum Leipzig, Leipzig, Germany
- Clinic of Otolaryngology, Head and Neck Surgery, Department of Head Medicine and Oral Health, University of Leipzig, Leipzig, Germany
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Physical and virtual modelling of the head and neck for surgical simulation and training. Curr Opin Otolaryngol Head Neck Surg 2016; 24:463-468. [DOI: 10.1097/moo.0000000000000303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Gross ND, Weber RS. Has the Pendulum Swung Back to Surgery First for Oropharyngeal Cancer? J Oncol Pract 2016; 12:1189-1191. [PMID: 27858542 DOI: 10.1200/jop.2016.017921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Neil D Gross
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Randal S Weber
- The University of Texas MD Anderson Cancer Center, Houston, TX
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Sobel RH, Blanco R, Ha PK, Califano JA, Kumar R, Richmon JD. Implementation of a comprehensive competency-based transoral robotic surgery training curriculum with ex vivo dissection models. Head Neck 2016; 38:1553-63. [DOI: 10.1002/hed.24475] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 01/20/2016] [Accepted: 03/16/2016] [Indexed: 11/09/2022] Open
Affiliation(s)
- Ryan H. Sobel
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins Hospital; Baltimore Maryland
| | - Ray Blanco
- Milton J. Dance Jr. Head and Neck Center, Greater Baltimore Medical Center; Towson Maryland
| | - Patrick K. Ha
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins Hospital; Baltimore Maryland
- Milton J. Dance Jr. Head and Neck Center, Greater Baltimore Medical Center; Towson Maryland
| | - Joseph A. Califano
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins Hospital; Baltimore Maryland
- Milton J. Dance Jr. Head and Neck Center, Greater Baltimore Medical Center; Towson Maryland
| | - Rajesh Kumar
- Department of Computer Science; Johns Hopkins University; Baltimore Maryland
| | - Jeremy D. Richmon
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins Hospital; Baltimore Maryland
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