Establishing a transoral robotic surgery program in an academic hospital in Germany

The application of robot technology in the field of surgery has grown rapidly in recent years. Also in Europe, robot-assisted surgery has become increasingly popular, predominantly in the fields of urology and gynecology. Transoral robotic surgery (TORS) is widely practiced in North America after receiving FDA approval in 2009. This technique was also adopted and is being practiced at specialized institutions in various European countries, including Germany. Due to significant differences in the health-care system and divergent developments of the use of transoral surgery in the treatment of laryngeal and pharyngeal malignancies in the last decade between North America and Europe, there are unique barriers and challenges to introducing TORS in these two parts of the world. This article describes experiences in developing a TORS program at an academic hospital in Germany. Specifically, steps that were required to obtain institutional approval and financial support, as well as to train surgeons and allied health-care personnel, and to establish a sufficient and adequate technique for reprocessing the used instruments are presented. Introducing a TORS program in Europe is still a challenge in regard to financial issues, acceptance, and practicability and therefore it is only practiced in specialized centers, although systems are widely available and often used in the same hospital by urology departments.