Transoral Robotik Cerrahinin Klinik Pratiğe Adaptasyonu: Tek Merkez Başlangıç Deneyimlerimiz ve Kısa Dönem Sonuçlar

Öz

Amaç: Bu çalışmada, transoral robotik cerrahi TORC ile ilgili başlangıç deneyimimizi, TORC’ un klinik pratiğimize uyarlanmasında yaşadığımız sorunları ve hastaların perioperatif ve erken dönem sonuçlarını sunmayı amaçladık.Gereç ve Yöntemler: Cerrahi tedavi gerektiren orofaringeal ve/veya hipofaringeal patoloji nedeniyle Nisan 2015 - Şubat 2018 tarihleri arasında kliniğimizde TORC uygulanan ardışık 70 hasta çalışmaya alındı. Hastaların demografik verileri, klinik bulguları ve perioperatif sonuçları prospektif olarak kaydedildi. Bulgular: Hastaların 60’ı erkek, 10’ u kadındı. Ortalama yaş 44,8±8,3, ortalama vücut kitle indeksi ise 31,9±3,5 kg/m2 idi. En genç hasta dört aylık bir infant idi. Hastaların %68,6’sında Mallampati skoru ≥3 idi. Elli hastaya obstrüktif uyku apnesi OSA nedeniyle dil kökü rezeksiyonu uygulandı. Baş-boyun tümörü olan dokuz hastadan altısına supraglottik parsiyel larinjektomi, ikisine dil kökü rezeksiyonu, bir hastaya da kordektomi uygulandı. Bilateral kord paralizisi olan yedi hastaya posterior kordektomi ile birlikte aritenoidektomi yapıldı. Farklı endikasyonlarla, birer hastaya dil kökünden lenfanjiyom eksizyonu, lingual tiroglossal duktus kisti eksizyonu, valleküler kist eksizyonu ve laringosel eksizyonu yapıldı. Tüm hastalarda TORC başarıyla tamamlandı. Olguların hiçbirinde kan transfüzyonu gerekmedi. Robotik sistemin ortalama kurulum süresi tüm prosedürler için 15 ilâ 18 dakika arasında değişmekte idi. Uygulanan cerrahilerin heterojenitesinden dolayı operasyon süreleri farklılık göstermekteydi. Perioperatif minör komplikasyonlar gözlendi. Dilde ödem, en sık intraoperatif komplikasyondu. Hastanede kalış süreleri cerrahi rezeksiyonların genişliği ile paralel, 1-13 gün arasında değişmekteydi.Sonuç: TORC, açık ve konvansiyonel endoskopik cerrahi ile erişimin güç olduğu orofaringeal ve/veya hipofaringeal patolojilerin cerrahi tedavisinde, minimal perioperatif komplikasyonları olan, etkin bir tedavi yöntemidir

Anahtar Kelimeler

• Transoral robotik cerrahi, Üst hava yolu, Perioperatif sonuçlar

Implementation of Transoral Robotic Surgery into Clinical Practice: Single Institution Initial Experience with Short-term Outcomes

Abstract

Objective: In this study, we aimed to present our initial experience and challenges that we encountered in adaptation of transoral robotic surgery TORS into our clinical practice, with perioperative and short term outcomes. Material and Methods: A total of 70 consecutive patients who underwent TORS between April 2015 and February 2018 in our clinic due to oropharyngeal and/or hypopharyngeal pathology requiring surgical treatment were included in the study. Demographic data, clinical findings and perioperative outcomes were recorded prospectively.Results: Of the patients, 60 were male and 10 were female. The mean age was 44.8±8.3 years, while mean body mass index was 31.9±3.5 kg/m2. The youngest patient was a 4-month-old infant. Of the patients, 68.6% had a Mallampati score of ≥3. A tongue base resection was performed in 50 patients with obstructive sleep apnea OSA . Of the nine patients with head and neck tumor, six underwent supraglottic partial laryngectomy, two underwent tongue base resection, and one underwent cordectomy. A posterior cordectomy combined with arytenoidectomy was performed in 7 patients with bilateral cord paralysis. Excisions of lymphangioma, lingual thyroglossal duct cyst, vallecular cyst and laryngocele were performed in one patient each with different indications. TORS was completed in all patients successfully. A blood transfusion was not needed in any patient. The mean robotic set-up time for all procedures was in the range of 15 to 18 minutes. Due to the heterogeneity of surgeries performed, operation times differed between procedures. Minor perioperative complications were observed. Tongue edema was the most common intraoperative complication. The length of hospital stay was in the range of 1 to 13 days in parallel with the extent of surgical resections.Conclusion: TORS is an effective treatment approach with minimal perioperative complications in the surgical treatment of oropharyngeal and/or hypopharyngeal pathologies that are difficult to access via open or conventional endoscopic surgery

Keywords

• Transoral robotic surgery, Upper airway, Perioperative outcomes

Kaynakça

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