Transoral Cordectomy with Microelectrodes (TOMES) on an Outpatient Basis: Advancing Patient Comfort and Personalized...

Background/Objectives: Outpatient surgery enhances patient comfort while reduces surgical wait times and healthcare costs compared to inpatient procedures. This study evaluates the individual feasibility of performing transoral trans muscular cordectomies with microelectrodes (TOMES) on an outpatient basis. Methods: This observational study analyses TOMES types III, IV, and V cordectomies performed from January 2002 to December 2023. Key metrics include patient demographics, procedural details, incidence of bleeding, anticoagulation and other comorbidities. Results: Of the 143 procedures, 127 were cancer-related, while 16 were due to bilateral vocal cord paralysis. The average age was 65, with a predominantly male cohort (92%). Postoperative hemorrhage occurred in four cases, primarily among oncological patients, but there was no correlation with anticoagulation therapy. A personalized predictive model for bleeding risk was developed based on patient-specific characteristics and observed outcomes. Additionally, performing the procedure on an outpatient basis decreased healthcare costs and wait times for patients with T1/T2 glottic carcinoma. Conclusions: The findings indicate that TOMES type III or higher cordectomies can be safely performed on an outpatient basis, through the use of a personalized predictive model for each case and with appropriate postoperative monitoring. This approach has the potential to lower healthcare costs and improve patient quality of life through individualized assessments and structured risk analysis.