Transoral Robotic Surgery (TORS) Using the Da Vinci Xi: a Prospective Analysis of Feasibility and Safety

Abstract

Introduction: The Da Vinci Xi robot has not been FDA approved for transoral surgical treatment (TORS) of head and neck cancers, resulting in limited data in the literature with regards to feasibility, safety and postoperative outcomes. We report feasibility and safety of Xi-TORS. Methods: In a prospective observational study, patients undergoing TORS with the Xi robot were consecutively included. The objective was evaluating feasibility and safety of Xi-TORS. Results: Sixty-one patients were included and adequate tumor exposure with macroscopically complete resection was obtained in 59 cases (success rate 96.7%). Of these 59 patients, 52 (88.1%) underwent TORS as a primary treatment and 7 (11.9%) were treated in a salvage setting. Most frequent indications were oropharyngeal squamous cell carcinoma (n = 25) and carcinoma of unknown primary (CUP) (n = 19). Mean robot docking time was 20.3 minutes and mean transoral robot time was 48.4 minutes. In 47.5% of patients, 44 peroperative difficulties were encountered. These were most frequently mild (86.4% of reported difficulties) as they only prolonged surgery without intervention interruption and were most often related to tumor exposure and/or robot setup (61.4%). No serious peroperative difficulties with adverse effect on procedure and/or patients were observed. Peroperative complications occurred in 20.3% of patients and most frequently consisted of minor dental damage (n = 5) and peroperative hemorrhage which was controlled transorally (n = 2). Serious complications were creation of an unintended TORS site-dissected neck fistula (n = 1) and iatrogenic mandibular fracture (n = 1). Postoperative hemorrhage at the TORS site and in the neck occurred in 11.9% and 5.1% of patients respectively. No postoperative deaths were encountered. Mean hospital stay was 9.9 days and readmission rate was 10.2%. Conclusion: Xi-TORS proves to be feasible and safe, with a high success rate, a low peroperative complication rate and postoperative hemorrhage rates within normal expectations. However, a high rate of mild peroperative technical difficulties are reported, most often related to exposure and/or robot setup. With the introduction of the Da Vinci Single Port system, a substantial decline in exposure/set-up related issues during TORS is expected, but this needs further confirmation.