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Learning curve for transoral robotic surgery: a 4-year analysis
Hilliary N White1, John Frederick, Terence Zimmerman
1Head and Neck Surgery Center of Florida, Florida Hospital Celebration Health, Celebration, FL 34747, USA.
JAMA Otolaryngology-- Head & Neck Surgery
|May 18, 2013
Summary
Transoral robotic surgery (TORS) learning curves show significant improvements in operative time, intubation duration, and hospital stay with increasing institutional experience. This 4-year study provides a benchmark for TORS adoption in head and neck cancer treatment.
Area of Science:
- Minimally Invasive Surgery
- Head and Neck Oncology
- Robotic Surgery Outcomes
Background:
- Transoral robotic surgery (TORS) is increasingly adopted by new institutions for head and neck tumor treatment.
- A need exists for a reference timeline of expected performance goals during the TORS learning curve.
- This study documents the 4-year experience of a single tertiary care academic institution with TORS.
Purpose of the Study:
- To evaluate the learning curve of transoral robotic surgery (TORS) over a 4-year period at a single institution.
- To report treatment trends and clinical outcomes associated with increasing TORS experience.
- To provide a benchmark for institutions adopting TORS for head and neck tumors.
Main Methods:
- Prospective case study of 168 patients undergoing TORS for head and neck tumors.
- Patients were divided into four consecutive groups of 42.
- Data collected included operative time, intubation length, hospital stay, margin status, and complications.
Main Results:
- Significant reductions observed in operative time (47%), intubation duration (87%), and hospital stay (from 3.0 to 1.4 days) with increased TORS experience.
- No significant differences noted in robotic case conversion rates, tumor characteristics, margin positivity, salvage rates, or need for tracheostomy/feeding tubes.
- The learning curve demonstrated clear improvements in efficiency and resource utilization over the 4-year period.
Conclusions:
- This study is the first multiyear prospective analysis of a single institution's TORS experience.
- It demonstrates specific, measurable improvements in key metrics as surgical experience grows.
- The findings provide valuable insights for institutions incorporating TORS into their practice.
