1
|
Zhang Z, Yao X, Li Y, Dong R, Jin W, Li Y. DRG payment for male reproductive system malignant tumor surgery: analysis and recommendations on resource consumption in a tertiary hospital in China. BMC Surg 2025; 25:207. [PMID: 40361068 PMCID: PMC12076853 DOI: 10.1186/s12893-025-02940-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2025] [Accepted: 04/29/2025] [Indexed: 05/15/2025] Open
Abstract
AIM This study aimed to examine the consistency of resource consumption (cost homogeneity) and influencing factors of the diagnosis-related group (DRG) "major operations for malignant tumors of the male reproductive system with general complications or comorbidities" (MA13) and offer recommendations for improving the efficacy of the grouping. METHODS This retrospective study analyzed medical records and insurance settlement data of all MA13 patients admitted to a tertiary urology department from January 2021 to December 2024. Combined with semi-structured interviews with urologists, key clinical cost drivers were identified. Multiple linear regression analysis was utilized to assess the significance of these factors and their specific impact on various service costs. We provided recommendations for improving MA13 groupings and evaluated their effectiveness using the coefficient of variation (CV) and t-tests. RESULTS The CV for the MA13 group was 0.41. Age and robot-assisted surgery emerged as independent factors due to their statistically dominant effects (P < 0.001) in multivariate regression, whereas comorbidities and insurance type showed limited explanatory power (adjusted R2 = 0.72). Subgrouping MA13 by age and robotics reduced intra-group heterogeneity (CV: 0.12-0.35 vs. 0.41), enabling equitable reimbursement for advanced surgical techniques while maintaining manageable DRG categories. CONCLUSIONS Supplementary payments for robot-assisted surgery should be considered to ensure equitable access to advanced technologies while maintaining cost-effectiveness. Stratified validation methods are essential for evaluating grouping effectiveness, which can help improve intra-group consistency and facilitate a more equitable distribution of medical resources.
Collapse
Affiliation(s)
- Zhengyu Zhang
- Medical Records Department, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Xiaolin Yao
- Department of urology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 311100, China
| | - Ying Li
- Department of Medical Administration, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Ruiyin Dong
- Medical Records Department, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Wen Jin
- Medical Records Department, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Yunhe Li
- Department of Medical Administration, The First Hospital of Lanzhou University, Lanzhou, 730000, China.
| |
Collapse
|
2
|
Tsitsika MA, Katsinis S, Damaskos C, Kykalos S, Tsourouflis G, Garmpis N, Dimitroulis D. A Systematic Review of Current Practices, Challenges, and Future Directions for the Use of Robotic Surgery in Otolaryngology in Greece. Cureus 2024; 16:e74458. [PMID: 39726518 PMCID: PMC11671053 DOI: 10.7759/cureus.74458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2024] [Indexed: 12/28/2024] Open
Abstract
Robotic surgery is increasingly used in otolaryngology (ENT), particularly for complex head and neck procedures. It offers various advantages, including limited postoperative pain, excellent aesthetic results, better visualization in the surgical field, enhanced dexterity due to movement adjustment by the robotic system, and minimal complications and hospital stay. However, robotic systems' higher cost and limited availability are a burden for clinical applications. This systematic review is a detailed assessment that looks at the existing situation, problems, and prospects for robotic ENT surgery in Greece. It is based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. The included studies were chosen based on specific criteria after a thorough inspection of electronic databases of clinical trials and medical journals (PubMed, Scopus, Web of Science). Despite steady adoption, Greece needs to catch up with other European countries in deploying robotic surgery technology. Various possible reasons may cause the small number of ENT robotic-assisted surgeries, including the high cost and the availability of robotic systems, mainly in large private or public hospitals in the main cities of Greece (Athens and Thessaloniki). Training on robotic systems is also very limited for surgery residents and young surgeons, while the learning curve of robotic-assisted surgeries in ENT is big. Peer-reviewed literature was analyzed to compare it with other European nations and investigate the economic, training, and geographic aspects that may be a burden for the rise of robotic surgery in Greece. Through the review scope, this study also provided recommendations concerning the implementation of robotic surgery in daily practice among surgeons in Greece and the difficulties that may arise regarding robotic surgery training in resource-limited countries.
Collapse
Affiliation(s)
| | - Spyros Katsinis
- Department of Otolaryngology, Laiko General Hospital, Athens, GRC
| | - Christos Damaskos
- Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Medical School, National and Kapodistrian University of Athens, Athens, GRC
- Department of Emergency Surgery, Laiko General Hospital, Athens, GRC
- N.S. Christeas Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, Athens, GRC
| | - Stylianos Kykalos
- Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Medical School, National and Kapodistrian University of Athens, Athens, GRC
- Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, GRC
| | - Gerasimos Tsourouflis
- Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, GRC
- Second Department of Propedeutic Surgery, Laiko General Hospital, Athens, GRC
| | - Nikolaos Garmpis
- Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Medical School, National and Kapodistrian University of Athens, Athens, GRC
- Department of Surgery, Sotiria General Hospital, Athens, GRC
| | - Dimitrios Dimitroulis
- Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Medical School, National and Kapodistrian University of Athens, Athens, GRC
- Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, GRC
| |
Collapse
|
3
|
Lechien JR, Hamdan AL, Fakhry N, Vaira LA, Iannella G, Gengler IM, Michel J, Radulesco T, Remacle M, Hans S, Cammaroto G, Saibene AM, Mayo-Yanez M, Maniaci A. Perception of Young European Otolaryngologists toward Transoral Robotic Surgery in Head and Neck Oncology and Surgery. J Clin Med 2024; 13:3055. [PMID: 38892767 PMCID: PMC11172773 DOI: 10.3390/jcm13113055] [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: 04/25/2024] [Revised: 05/19/2024] [Accepted: 05/20/2024] [Indexed: 06/21/2024] Open
Abstract
Background: To investigate the perception of young European otolaryngologists (OTOs), i.e., head and neck surgeons, toward transoral robotic surgery (TORS). Methods: Members of the Young Confederation of European Otorhinolaryngology-Head and Neck Surgery and Young Otolaryngologists of International Federation of Otorhinolaryngological Societies were surveyed about TORS perception and practice. Results: The survey was completed by 120 young OTOS (26%). The most important barriers to TORS were robot availability (73%), cost (69%), and lack of training (37%). The participants believed that the main benefits include better surgical filed view (64%), shorter hospital stay (62%), and better postoperative outcomes (61%) than the conventional approach. Head and neck surgeons considered cT1-T2 oropharyngeal cancers (94%), resection of base of tongue for sleep apnea (86%), or primary unknown cancer (76%) as the most appropriate indications. A total of 67% of TORS surgeons assessed themselves as adequately trained in TORS. Conclusions: Young European OTOs report positive perception, adoption, and knowledge of TORS. The cost-related unavailability and the lack of training or access are reported to be the most important barriers for the spread of TORS.
Collapse
Affiliation(s)
- Jerome R. Lechien
- Robotic Study Group of Young Otolaryngologists, International Federation of Otorhinolaryngological Societies (YO-IFOS), 13005 Paris, France; (N.F.); (L.A.V.); (G.I.); (I.M.G.); (J.M.); (T.R.); (S.H.); (G.C.); (A.M.S.); (A.M.)
- Department of Otolaryngology and Head and Neck Surgery, Foch Hospital, Paris Saclay University, 91190 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), 7000 Mons, Belgium
- Elsan Polyclinic of Poitiers, 86000 Poitiers, France
- Laboratory of Anatomy and Cell Biology, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMONS), Avenue du Champ de Mars, 6, 7000 Mons, Belgium
| | - Abdul-Latif Hamdan
- Department of Otolaryngology-Head and Neck Surgery, American University of Beirut Medical Center, Beirut 1107, Lebanon;
| | - Nicolas Fakhry
- Robotic Study Group of Young Otolaryngologists, International Federation of Otorhinolaryngological Societies (YO-IFOS), 13005 Paris, France; (N.F.); (L.A.V.); (G.I.); (I.M.G.); (J.M.); (T.R.); (S.H.); (G.C.); (A.M.S.); (A.M.)
- Department of Otolaryngology and Head and Neck Surgery, Aix-Marseille Univ, AP-HM, La Conception Hospital, 13005 Marseille, France
| | - Luigi A. Vaira
- Robotic Study Group of Young Otolaryngologists, International Federation of Otorhinolaryngological Societies (YO-IFOS), 13005 Paris, France; (N.F.); (L.A.V.); (G.I.); (I.M.G.); (J.M.); (T.R.); (S.H.); (G.C.); (A.M.S.); (A.M.)
- Maxillofacial Surgery Operative Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Giannicola Iannella
- Robotic Study Group of Young Otolaryngologists, International Federation of Otorhinolaryngological Societies (YO-IFOS), 13005 Paris, France; (N.F.); (L.A.V.); (G.I.); (I.M.G.); (J.M.); (T.R.); (S.H.); (G.C.); (A.M.S.); (A.M.)
- Department of “Organi di Senso”, University “Sapienza”, 00161 Rome, Italy
| | - Isabelle M. Gengler
- Robotic Study Group of Young Otolaryngologists, International Federation of Otorhinolaryngological Societies (YO-IFOS), 13005 Paris, France; (N.F.); (L.A.V.); (G.I.); (I.M.G.); (J.M.); (T.R.); (S.H.); (G.C.); (A.M.S.); (A.M.)
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati Medical Center, Cincinnati, OH 45267, USA
| | - Justin Michel
- Robotic Study Group of Young Otolaryngologists, International Federation of Otorhinolaryngological Societies (YO-IFOS), 13005 Paris, France; (N.F.); (L.A.V.); (G.I.); (I.M.G.); (J.M.); (T.R.); (S.H.); (G.C.); (A.M.S.); (A.M.)
- Aix Marseille University, APHM, CNRS, IUSTI, La Conception University Hospital, ENT-HNS Department, 13005 Marseille, France
| | - Thomas Radulesco
- Robotic Study Group of Young Otolaryngologists, International Federation of Otorhinolaryngological Societies (YO-IFOS), 13005 Paris, France; (N.F.); (L.A.V.); (G.I.); (I.M.G.); (J.M.); (T.R.); (S.H.); (G.C.); (A.M.S.); (A.M.)
- Aix Marseille University, APHM, CNRS, IUSTI, La Conception University Hospital, ENT-HNS Department, 13005 Marseille, France
| | - Marc Remacle
- Department of Otolaryngology and Head and Neck Surgery, Foch Hospital, Paris Saclay University, 91190 Paris, France;
- Department of Otolaryngology, Head and Neck Surgery, Eich Hospital, 1460 Eich, Luxembourg
| | - Stephane Hans
- Robotic Study Group of Young Otolaryngologists, International Federation of Otorhinolaryngological Societies (YO-IFOS), 13005 Paris, France; (N.F.); (L.A.V.); (G.I.); (I.M.G.); (J.M.); (T.R.); (S.H.); (G.C.); (A.M.S.); (A.M.)
- Department of Otolaryngology and Head and Neck Surgery, Foch Hospital, Paris Saclay University, 91190 Paris, France;
| | - Giovanni Cammaroto
- Robotic Study Group of Young Otolaryngologists, International Federation of Otorhinolaryngological Societies (YO-IFOS), 13005 Paris, France; (N.F.); (L.A.V.); (G.I.); (I.M.G.); (J.M.); (T.R.); (S.H.); (G.C.); (A.M.S.); (A.M.)
- Department of Otolaryngology-Head and Neck Surgery, Forli Hospital, 47122 Forli, Italy
| | - Alberto M. Saibene
- Robotic Study Group of Young Otolaryngologists, International Federation of Otorhinolaryngological Societies (YO-IFOS), 13005 Paris, France; (N.F.); (L.A.V.); (G.I.); (I.M.G.); (J.M.); (T.R.); (S.H.); (G.C.); (A.M.S.); (A.M.)
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, 26900 Milan, Italy
| | - Miguel Mayo-Yanez
- Robotic Study Group of Young Otolaryngologists, International Federation of Otorhinolaryngological Societies (YO-IFOS), 13005 Paris, France; (N.F.); (L.A.V.); (G.I.); (I.M.G.); (J.M.); (T.R.); (S.H.); (G.C.); (A.M.S.); (A.M.)
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital San Rafael (HSR), 15006 A Coruña, Spain
| | - Antonino Maniaci
- Robotic Study Group of Young Otolaryngologists, International Federation of Otorhinolaryngological Societies (YO-IFOS), 13005 Paris, France; (N.F.); (L.A.V.); (G.I.); (I.M.G.); (J.M.); (T.R.); (S.H.); (G.C.); (A.M.S.); (A.M.)
- Faculty of Medicine and Surgery, University of Enna Kore, 94100 Enna, Italy
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Lechien JR, Hans S. Are new and young generations of surgeons more aware of transoral robotic surgery than older ones? An international survey. J Robot Surg 2023; 17:2065-2072. [PMID: 37204649 DOI: 10.1007/s11701-023-01619-6] [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: 02/11/2023] [Accepted: 05/13/2023] [Indexed: 05/20/2023]
Abstract
The objective of this study is to investigate adoption, perception, and awareness of otolaryngologist-head neck surgeons (OTO-HNS) toward transoral robotic surgery (TORS) according to the surgeon experience. A total of 1,383 OTO-HNS of YO-IFOS and IFOS received an online survey dedicated to the adoption, perception, and awareness toward TORS. The following outcomes were compared between residents and fellows, young/middle-aged and older OTO-HNS: awareness/perception; indications; advantages; barriers and expected improvements of TORS practice. From the 357 responders (26%), 147 participants were residents and fellows; while 105 and 105 OTO-HNS reported 10 to 19, and more than 20 years of practice. The main barriers of using TORS included the cost and the availability of robot, and the lack of training opportunity. The better view of the operative field and the shorter patient hospital stay were considered as the main advantages. Older surgeons trust more likely in TORS benefits (p = 0.001) and surgical field view advantages (p = 0.037) compared to younger participants. TORS is an important surgical minimal invasive approach for the future for 46% of residents and fellows versus 61% of older OTO-HNS (p = 0.001). Compared to older OTO-HNS, residents and fellows reported more frequently that the lack of training opportunity is the main barrier of TORS (52% versus 12%; p = 0.001). Residents and fellows did not share the same expectations of robot improvement for the future than older OTO-HNS. Experienced OTO-HNS had better perception and trust toward TORS than residents and fellows. Residents and fellows identified the lack of training opportunity as the main barrier to the use of TORS. TORS access and training programs need to be improved in academic hospitals for residents and fellows.
Collapse
Affiliation(s)
- Jerome R Lechien
- 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), Mons, Belgium.
- Department of Otolaryngology and Head and Neck Surgery, Foch Hospital, Paris Saclay University, Paris, France.
- Elsan Polyclinic of Poitiers, Poitiers, France.
- Department of Otolaryngology-Head and Neck Surgery, CHU Saint-Pierre, Brussels, Belgium.
- Laboratory of Anatomy and Cell Biology, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMONS), Avenue du Champ de mars, 6, B7000, Mons, Belgium.
| | - Stephane Hans
- Department of Otolaryngology and Head and Neck Surgery, Foch Hospital, Paris Saclay University, Paris, France
| |
Collapse
|
6
|
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: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [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.
Collapse
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
| |
Collapse
|
7
|
Mulcahy CF, Gross ND. Advances in Surgical Therapy for HPV-Associated Squamous Cell Carcinoma. CURRENT OTORHINOLARYNGOLOGY REPORTS 2022. [DOI: 10.1007/s40136-022-00421-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
|