Robot-assisted vaginal hysterectomy: two cases

Hysterectomy remains the most frequent surgical gynaecological procedure. We report two cases of robot-assisted vaginal hysterectomy and show its feasibility. Robotic assistance in vaginal hysterectomy could combine both the advantage of the vaginal route (reducing surgical length, blood loss, hospitalisation and recovery), and the advantage of the robot assistance (3D endoscopic vision, easier instrumental handling, surgical ergonomics) especially when the hysterectomy is difficult. It could be used in other pathologies that are already treated by vaginal route.

Initial multi-institutional experience with transoral robotic surgery

OBJECTIVE

To assess the initial experience for transoral robotic surgery (TORS), as observed in the French TORS group.

STUDY DESIGN

A multi-institutional prospective cohort study.

SETTING

Seven tertiary referral centers.

SUBJECTS AND METHODS

One hundred thirty consecutive patients who were scheduled for a TORS between October 2008 and March 2011 were included. The operative times, conversion rates, morbidity, and alternatives were described. The serious adverse effects encountered were analyzed, and recommendations for avoiding them are specified.

RESULTS

Most of the patients (65%) had a laryngeal (supraglottic) and/or hypopharyngeal resection. Thirty-nine of the 130 patients receiving TORS would have had a transoral laser resection as their alternative surgery. The tumor exposure was suboptimal in 26% of the cases. Six of the 130 patients needed conversion to an open approach. There were 15 postoperative hemorrhages and 2 deaths due to posthemorrhage complications in patients with significant comorbidities at 9 and 18 days after the surgery. The median setup and procedure times were 52 ± 46 and 90 ± 92 minutes, respectively. The learning curve was characterized by better selection and management of potential patients.

CONCLUSION

The visualization offered by the robotic assistance allowed transoral resections of tumors that were difficult to resect or unresectable by laser surgery. Self-assessment of surgical exposure and a decrease in the need to convert to an open procedure over time suggested improvement in TORS-related surgical skills. Nevertheless, strict patient selection is essential. Even with a minimally invasive approach, some patients will need a tracheostomy for safety reasons.

Transoral robotic surgery for head and neck cancer: a series of 17 cases

OBJECTIVES

Transoral robotic surgery (TORS) is an innovative surgical technique indicated for resection of selected head and neck cancers. The authors report their experience and discuss the indications, advantages and disadvantages of this technique.

MATERIALS AND METHODS

Seventeen patients were operated by TORS in the Limoges University Hospital ENT department between March 2010 and January 2011.

RESULTS

Tumour sites were the aryepiglottic fold (n=3), piriform sinus (n=2), lateral pharyngeal wall (n=3), posterior pharyngeal wall (n=2), base of tongue (n=3), vallecula (n=1), epiglottis (n=2) and arytenoid (n=2). One patient had two primary sites treated by TORS. This series comprised two stage I (11.7%), seven stage II (41.2%), six stage III (35.4%) and two stage IVa tumours (11.7%). Mean TORS set-up and operating times were 20.5 and 39.7 minutes, respectively. No major intraoperative complication was observed. One patient was reoperated on D5 for bleeding. Fifteen patients had clear surgical margins. Swallowing was restored on D2 for nine patients. The mean length of hospital stay was 10 days. Seven patients received adjuvant radiotherapy, seven patients were treated by chemoradiotherapy and three patients were submitted to simple clinical surveillance.

CONCLUSION

TORS appears to provide new treatment options for head and neck cancers by extending the indications for endoscopic resection for selected cases of head and neck cancers. It allows effective cancer resection under excellent operating conditions with low morbidity and improved functional recovery. This new treatment modality needs to be evaluated in relation to other open surgery, endoscopic laser and chemoradiotherapy techniques.

Transoral Robotic Surgery for the Treatment of Head and Neck Cancer of Various Localizations

Background. Transoral robotic surgery (TORS) is a recent endoscopic technique to resect selected head and neck cancers. Study design. In total, 13 patients underwent TORS procedure for resection of head and neck cancers of various localizations, within the ENT Department of Limoges University Hospital Center between March and October 2010. Results. Tumor localizations were aryepiglottic fold (n = 3), pyriform sinus (n = 2), posterior pharyngeal wall (n = 2), base of tongue (n = 2), lateral pharyngeal wall (n = 2), vallecula (n = 1), and epiglottis (n = 1). Average TORS setup time was 23 minutes. Average TORS operative time was 45 minutes. Average hospital stay was 8.4 days. Conclusions. TORS is a new technique that permits excellent resection of selected head and neck cancers with poor morbidity. Future reports on long-term oncologic and functional outcomes are needed to assess the risks and benefits of this approach compared with external approaches and nonsurgical alternatives.