Adoption of otolaryngologist-head neck surgeons toward transoral robotic surgery: An international survey

Jerome R Lechien; Leonardo Haddad; F Christopher Holsinger; Abie H Mendelsohn; Stephane Hans

doi:10.1002/lio2.1003

Adoption of otolaryngologist-head neck surgeons toward transoral robotic surgery: An international survey

Laryngoscope Investig Otolaryngol. 2022 Dec 25;8(1):95-102. doi: 10.1002/lio2.1003. eCollection 2023 Feb.

Authors

Jerome R Lechien^{1

2

3

4}, Leonardo Haddad⁵, F Christopher Holsinger⁶, Abie H Mendelsohn⁷, Stephane Hans¹

Affiliations

¹ Department of Otolaryngology and Head and Neck Surgery, Foch Hospital Paris Saclay University Paris France.
² Department of Otolaryngology and Head and Neck Surgery, Division of Broncho-Esophagology, EpiCURA Hospital UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons) Mons Belgium.
³ Department of Otolaryngology Elsan polyclinic of Poitiers Poitiers France.
⁴ Department of Otolaryngology-Head and Neck Surgery CHU Saint-Pierre Brussels Belgium.
⁵ Department of Otolaryngology, Head and Neck Surgery Federal University of São Paulo São Paulo Brazil.
⁶ Division of Head and Neck Surgery Stanford University Palo Alto California USA.
⁷ Department of Head and Neck Surgery David Geffen School of Medicine at UCLA Los Angeles California USA.

Abstract

Objective: To investigate perception, adoption and awareness of otolaryngologist-head neck surgeons (OTO-HNS) toward transoral robotic surgery (TORS).

Methods: An online survey was sent to 1383 OTO-HNS on the perception, adoption and awareness about TORS to members of many otolaryngological societies. The following aspects were assessed: TORS access; training; awareness/perception; indications and advantages/barriers to TORS practice. The responses were presented for the entire cohort and regarding the TORS experience of OTO-HNS.

Results: A total of 359 completed the survey (26%); including 115 TORS surgeons. TORS-surgeons carry out a mean number of 34.4 annual TORS procedures. The primary barriers to TORS were the cost of the robot (74%) and disposable accessories (69%), and the lack of training opportunity (38%). The 3D view of the surgical field (66%), the postoperative quality of life outcomes (63%) and the shorter hospital stay (56%) were the most important benefits of TORS. TORS-surgeons believed more frequently that TORS is indicated for cT1-T2 oropharyngeal and supraglottic cancers than non-TORS surgeons (p < .005). Participants believed that the priorities for the future consisted of the reduction of the robot arm size and the incorporation of flexible instruments (28%); the integration of laser (25%) or GPS tracking based on imaging (18%), all of them to improve accesses to hypopharynx (24%), supraglottic larynx (23%) and vocal folds (22%).

Conclusions: The perception, adoption and knowledges toward TORS depend on the access to robot. The findings of this survey may help guide decisions on how improve the dissemination of TORS interest and awareness.

Keywords: Transoral; awareness; head neck; otolaryngology; robotic; surgery; survey.