Redefining Minimally Invasive Head and Neck Surgery without Robotics: the First Romanian TOUSS Experience

Transoral ultrasonic surgery (TOUSS) has emerged as a minimally invasive technique for the treatment of head and neck malignancies, offering oncologic outcomes comparable to robotic-assisted approaches, but with lower costs and wider accessibility.

This study aims to evaluate the clinical and functional outcomes of TOUSS in a single-institution cohort, including the first documented cases of total transoral laryngectomy performed via TOUSS in Romania.

A retrospective observational analysis was conducted on 39 patients treated at Colțea Clinical Hospital between 2018 and 2024. Eligible patients had T1-T3 squamous cell carcinomas of the oropharynx, oral cavity, supraglottis, or larynx, with appropriate transoral exposure. Data on demographics, tumor characteristics, perioperative outcomes and three-year follow-up were collected.

The majority of tumors involved the oropharynx (n=21), followed by the lateral or base of the tongue (n=14), with two cases requiring total laryngectomy. Tracheostomy was avoided in all patients. Nasogastric tube removal occurred by day 10, and the average hospital stay was seven days. At three years, 79.5% of patients remained disease-free, with 10.3% recurrence and 10.3% lost to follow-up. Postoperative complications were minimal and surgically controlled.

Transoral ultrasonic surgery is a safe and effective alternative to robotic surgery, achieving favorable oncologic and functional outcomes. Its feasibility for total laryngectomy and cost-effectiveness makes it a promising option for wider adoption, particularly in low-resource settings.