Transoral Robotic Surgery

OBJECTIVE: To describe and show the feasibility of a new surgical technique for transoral robotic surgery (TORS) radical tonsillectomy. DESIGN: A prospective, phase 1 clinical trial. SETTING: Academic, tertiary referral center. PATIENTS: A total of 27 participants were prospectively selected using a volunteer sample. All eligible patients agreed to participate in the study. INTERVENTIONS: Patients underwent TORS radical tonsillectomy for previously untreated invasive squamous cell carcinoma of the tonsillar region without free-flap reconstruction, staged neck dissection, and adjuvant therapy. MAIN OUTCOME MEASURES: Outcome measures included final pathologic margin status, need for short- and long-term tracheotomy tube placement, and need for gastrostomy tube feedings among patients with a minimum 6-month follow-up. The incidence of significant postoperative complications was recorded. RESULTS: No mortality occurred. Final margins found to be negative for cancer were achieved in 25 of 27 patients (93%). Surgical complications included 1 case each of postoperative mucosal bleeding, delirium tremens, unplanned tracheotomy for temporary exacerbation of sleep apnea, and hypernasality and 2 cases of moderate trismus. Twenty-six of 27 patients (96%) were swallowing without the use of a gastrostomy. CONCLUSIONS: Radical tonsillectomy using TORS is a new technique that offers excellent access for resection of carcinomas of the tonsil with acceptable acute morbidity. Future reports will focus on long-term oncologic and functional outcomes.