Expert perspectives for transoral robotic versus laser surgery for supraglottic carcinomas

Charlotte Loubieres; Stéphane Hans; Jerome R Lechien; Mohssen Ansarin; Sarah Atallah; Jonathan Barbut; Alain Bizeau; Brian Burkey; Philippe Céruse; Olivier Choussy; Florent Couineau; Erwan De Mones Del Pujol; Gilles Dolivet; Nicolas Fakhry; Renaud Garrel; Roland Giger; Wojciech Golusiński; Philippe Gorphe; Clémence Lorentz; Olivier Malard; Giuseppe Meccariello; Sylvain Morinière; Raul Pellini; Nicolas Saroul; Marta Tagliabue; Sebastien Vergez; Isabel Vilaseca; Alexandre Villeneuve; Robin Baudouin

doi:10.1007/s00405-024-09070-5

Expert perspectives for transoral robotic versus laser surgery for supraglottic carcinomas

Eur Arch Otorhinolaryngol. 2024 Nov 28. doi: 10.1007/s00405-024-09070-5. Online ahead of print.

Authors

Charlotte Loubieres^{1

2}, Stéphane Hans^{1

2

3}, Jerome R Lechien^{1

2

4

5

6}, Mohssen Ansarin⁷, Sarah Atallah⁸, Jonathan Barbut⁹, Alain Bizeau⁹, Brian Burkey¹⁰, Philippe Céruse¹¹, Olivier Choussy¹², Florent Couineau^{1

2}, Erwan De Mones Del Pujol¹³, Gilles Dolivet¹⁴, Nicolas Fakhry¹⁵, Renaud Garrel¹⁶, Roland Giger¹⁷, Wojciech Golusiński¹⁸, Philippe Gorphe¹⁹, Clémence Lorentz²⁰, Olivier Malard²¹, Giuseppe Meccariello²², Sylvain Morinière²³, Raul Pellini²⁴, Nicolas Saroul²⁵, Marta Tagliabue⁷, Sebastien Vergez²⁶, Isabel Vilaseca²⁷, Alexandre Villeneuve²⁸, Robin Baudouin^{29

30}

Affiliations

¹ Department of Otolaryngology-Head & Neck Surgery, Foch Hospital, Suresnes, France.
² School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Montigny-le-Bretonneux, France.
³ Phonetics and Phonology Laboratory (UMR 7018 CNRS &, Université Sorbonne Nouvelle), Paris, France.
⁴ Department of Otolaryngology, Elsan Hospital, Paris, France.
⁵ Department of Surgery, University of Mons, Mons, Belgium.
⁶ Division of Laryngology and Broncho-Esophagology, Department of Otolaryngology-Head & Neck Surgery, EpiCURA Hospital, Baudour, Belgium.
⁷ Department of Otorhinolaryngology-Head and Neck Surgery, European Institute of Oncology, IRCCS, Milan, Italy.
⁸ Department of Otorhinolaryngology-Head and Neck Surgery, Sorbonne University, Tenon Hospital, AP-HP, Paris, France.
⁹ Department of Otolaryngology and Head and Neck Surgery, Sainte Musse Hospital, Toulon, France.
¹⁰ Head & Neck Institute, Cleveland Clinic, Cleveland, OH, USA.
¹¹ Department of Otolaryngology-Head and Neck Surgery, Lyon-Nord Hospital, Lyon, France.
¹² Institut Curie Paris, Paris, France.
¹³ Department of Otolaryngology-Head and Neck Surgery, Pellegrin Hospital, University Hospital, CHU Bordeaux, France.
¹⁴ Department of Otolaryngology-Head and Neck Surgery, Cancerology Institute of Lorraine, Nancy, France.
¹⁵ Department of Oto-Rhino-Laryngology Head and Neck Surgery, La Conception University Hospital, AP-HM, Aix Marseille Univ, Marseille, France.
¹⁶ ENT Department, Neck Surgery and Maxillofacial Surgery, Gui de Chauliac University Hospital, Montpellier University School of Medicine, Montpellier, France.
¹⁷ Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
¹⁸ Department of Head and Neck Surgery, Poznan University of Medical Sciences and The Greater Poland Cancer Centre, Poznan, Poland.
¹⁹ Department of Head and Neck Oncology, Gustave Roussy Cancer Campus, Villejuif, France.
²⁰ Pasteur Kleber Health Center, Essey-les-Nancy, France.
²¹ Department of Otolaryngology Head and Neck Surgery, Nantes University Hospital, Nantes, France.
²² Department of Surgery, Otolaryngology, Head-Neck Surgery Unit, Morgagni Pierantoni Hospital, 47121, Forlì, Italy.
²³ Otorhinolaryngology Department, CHU Bretonneau, François Rabelais University, Tours, France.
²⁴ Department of Otolaryngology, Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, 00144, Rome, Italy.
²⁵ Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Center Gabriel Montpied, Clermont-Ferrand, France.
²⁶ Department of Head and Neck Surgery, University Hospital of Toulouse Larrey & Oncopole, Toulouse, France.
²⁷ Otorhinolaryngology Head-Neck Surgery Department, Hospital Clínic, IDIBAPS Universitat de Barcelona, Barcelona, Spain.
²⁸ Department of ENT Head and Neck Surgery, Percy Military Training Hospital, Clamart, France.
²⁹ Department of Otolaryngology-Head & Neck Surgery, Foch Hospital, Suresnes, France. [email protected].
³⁰ School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Montigny-le-Bretonneux, France. [email protected].

PMID: 39604555
DOI: 10.1007/s00405-024-09070-5

Abstract

Objective: To assess the opinion, practices, and challenges of international key opinion leaders about two minimal invasive surgical techniques in supraglottic laryngeal tumours: transoral laser microsurgery (TLM) and the transoral robotic surgery (TORS).

Methods: Design of a questionnaire composed of seven sections and fifty questions covering descriptive data of participants, practitioners experience procedural sequences, considerations related to airways, feeding, and voice, intraoperative haemorrhage, postoperative management, and a comparative analysis of TLM and TORS in treating supraglottic laryngeal cancer.

Results: A total of 27 head and neck surgeons replied to the survey. The experts had an average experience in laryngeal surgery of 20.0 ± 9.4 years, ranging from 5 to 36 years. We noted a significantly shorter installation time in TLM compared to TORS (19% of experts estimated the installation time of over 20 min with TLM vs 44% with TORS; p = 0.02). According to complications, the experts considered that bleeding was the major concern with supraglottic laryngeal surgery, especially intraoperative bleeding in TLM (52% in TLM vs 26% in TORS) (p = 0.09) and postoperative bleeding in TORS (56% in TORS vs 44% in TLM).

Conclusion: The experts did not identify a clear superiority of one technology (TLM) over the other (TORS). The two techniques seemed equivalent to the experts, except for the control of intraoperative haemostasis and visualisation of the surgical field, where TORS was perceived as superior to TLM.

Keywords: Carcinomas; Endoscopic surgery; Head and neck; Laryngeal cancer; Laser CO2; Minimally invasive surgery; Otolaryngology; Supraglottic laryngectomy; Survey; Transoral Laryngeal microsurgery; Transoral Robotic surgery.