Implementation of a TORS program in an academic medical center

Objectives: Transoral robotic surgery (TORS) is rapidly being adopted by many head and neck surgeons for treatment of upper aerodigestive tract tumors. Various obstacles exist to efficiently implement this novel surgical technique in a busy academic center. We present our experience to illustrate one approach to initiating a TORS program. Study Design: Prospective cohort study. Methods: A clear, stepwise approach to introduce TORS in our hospital was devised prior to scheduling the first case. Upon initiation of the program, various time points and surgical outcomes were measured for all patients undergoing TORS. Results: The first 20 cases of TORS at Johns Hopkins Hospital are reviewed. Room setup time averaged 24 minutes (±12). Presurgery time averaged 22 ± 10 minutes. Positioning time averaged 38 ± 13 minutes. Operative time (OT) averaged 71 ± 54 minutes. The total time in room (TTR) averaged 242 ± 84 minutes. There were no significant differences (P >.5) in any of the time measurements above between the first and second 10 cases or the first 15 and last 5 cases. Negative margins (both frozen and permanent) were obtained in all ablative cases. No patient required a tracheotomy and no procedure was aborted secondary to inability to expose the tumor. The average hospitalization time was 1.3 days. All patients were discharged on oral diets. There were no long-term surgical complications. Conclusions: The introduction of a TORS program in an academic medical center can be a complex and daunting undertaking. We demonstrate that with careful planning, excellent efficiency and safety can be attained immediately.