Trans-oral robotic surgery for head and neck cancers using the Medrobotics Flex® system: the Adelaide cohort

Oladejo Olaleye; Bola Jeong; Michael Switajewski; Eng H Ooi; Suren Krishnan; Andrew Foreman; John-Charles Hodge

doi:10.1007/s11701-021-01270-z

Trans-oral robotic surgery for head and neck cancers using the Medrobotics Flex^® system: the Adelaide cohort

J Robot Surg. 2022 Jun;16(3):527-536. doi: 10.1007/s11701-021-01270-z. Epub 2021 Jul 7.

Authors

Oladejo Olaleye¹, Bola Jeong², Michael Switajewski³, Eng H Ooi⁴, Suren Krishnan³, Andrew Foreman³, John-Charles Hodge³

Affiliations

¹ Department of Otolaryngology, Head and Neck Surgery, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia. dejolaleye@yahoo.com.
² Department of Otolaryngology, Head and Neck Surgery, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia.
³ Department of Otolaryngology, Head and Neck Surgery, Memorial Hospital, Adelaide, SA, 5000, Australia.
⁴ Otolaryngology, Head and Neck Surgery, Flinders Medical Centre, College of Medicine and Public Health, Flinders University, Bedford Park, Adelaide, SA, 5042, Australia.

PMID: 34232448
DOI: 10.1007/s11701-021-01270-z

Abstract

Trans-oral robotic surgery for head and neck cancers can be performed using rigid, multi-port robots with linear access but the Medrobotics Flex^® system offers an alternative as it is endo-luminal, single-port, and uses flexible instruments. To assess the utility of the Medrobotics Flex^® system for head and neck cancer (HNC) resections. A retrospective review of all HNC resections done over a 2.5-year period (Jan 2017-July 2019) at the Memorial Hospital, using the Flex^® system. Data collected include patient demographics, tumour site, tumour stage, p16 status, smoking history, surgery performed, histologic margins, complications, overall survival, recurrence, and adjuvant treatments received. There were 49 head and neck cancer cases in total done using the Medrobotics Flex^® system. Median age 60 years, with M:F ratio 3.5:1. Outcomes: oropharyngeal cancers (82%), p16 positive (89%), overall survival (94%), local recurrence (6%), and adjuvant treatment (84%). Cancer procedures done included lateral oropharyngectomy (43%), tongue base mucosectomy (27%), tongue base resection (18%), and others (12%) which include a single case each of supraglottic laryngectomy, hypopharyngeal tumour resection, partial pharyngectomy, partial glossectomy, and vocal cord tumour resection. Clear margins were related to tumour T stage and achieved for T1 tonsil cancer (75%), T2 tonsil cancer (70%), T3 tonsil cancer (50%), T1 tongue base cancer (80%), and T2 tongue base cancer (66.7%). Median operating time with neck dissection was 2 h 40 min, whilst median length of hospital stay was 1 day (IQR 1-7 days). Complications included a single case each of secondary haemorrhage (managed conservatively), oro-cervical fistula, wound infection, tongue numbness, and a medical event. There was no primary haemorrhage and no mortality. The Medrobotics Flex^® system is a safe and reliable tool for head and neck cancer surgery.

Keywords: Cancer, head and neck; FLEX; Medrobotics; Robotic; Surgery; Trans-oral.

MeSH terms

Head and Neck Neoplasms* / surgery
Humans
Laryngeal Neoplasms* / surgery
Laryngectomy / methods
Middle Aged
Oropharyngeal Neoplasms* / surgery
Robotic Surgical Procedures* / methods
Tonsillar Neoplasms* / surgery