Perioperative safety, feasibility, and oncologic utility of transoral robotic surgery with da Vinci Xi platform

Transoral robotic surgery (TORS) using the da Vinci Xi: prospective analysis of feasibility, safety, and outcomes

“…The most frequent postoperative complication was hemorrhage at the TORS site ( n = 7 [11.9%] of which 5 [8.5%] required re‐intervention for transoral hemostasis). This equals the 11.1% and 9.1% postoperative bleeding re‐intervention reported by Gorphe et al and Gabrysz et al, respectively 13,16 . Post‐operative Xi‐TORS hemorrhage rates match those in S/Si series 8,17,18 .…”

“…Based on these findings, Xi-TORS, like previous TORS platforms, achieves excellent oncological outcomes when standard surgical techniques, approaches, and indications are used. 16 Despite being the largest prospective study that assesses feasibility, safety, and outcomes of Xi-TORS for UADT malignancies in detail, this series suffers from limitations. First, our population is heterogeneous and includes, except for a majority of SCC, also non-SCC patients (n = 5).…”

“…13 When trying to reach the larynx or hypopharynx, however, other authors report that the 8-mm Xi instruments lead to crowding in the operating field with a reduced visibility, decreased agility of the wrist motion, increased internal collisions, and more frequent need for repositioning, slowing down the procedure. 8,15,16 However, these statements often derive from the author's opinions; objective data on procedural Xi-TORS difficulties encountered are lacking. 16 Therefore, we prospectively collected objective data on the success rate in achieving exposure combined with macroscopic complete tumor resection, peroperative difficulties, and complications.…”

“…Also, in their Xi experience, Gorphe et al rarely encounter “chopsticking,” and surely less than with the Si system 13 . When trying to reach the larynx or hypopharynx, however, other authors report that the 8‐mm Xi instruments lead to crowding in the operating field with a reduced visibility, decreased agility of the wrist motion, increased internal collisions, and more frequent need for repositioning, slowing down the procedure 8,15,16 . However, these statements often derive from the author's opinions; objective data on procedural Xi‐TORS difficulties encountered are lacking 16 .…”

“…Studies reporting on TORS performed with earlier da Vinci platforms have reported more favorable margin positivity rates (e.g., 9.9% in the large multi‐institutional study published by De Almeida et al 4 ). Other Xi‐TORS series report a 0% and 18.8% margin positivity that raises doubt about a potential Xi‐related higher margin positivity rate 13,16 . A recent review on transoral surgery for OPSCC confirmed that positive margins imply reduced local control and that intraoperative frozen sections reduce the definitive positive margin rate; thus, systematic frozen sections and re‐interventions to obtain definitive negative margins are recommended 21 …”