What´s new in PubMed this week
Wang JP, Li DP, Liu YC, Zhang L, Fu ZY, Liang BY, Yin SY, Yang YP, Fan M, Ding Z, Chen SW, Zhang L, Wu KL, Liu YH, Cao F, Pan HF, Han YX. Comparison of learning curves and related postoperative indicators between endoscopic and robotic thyroidectomy: a systematic review and meta-analysis. Int J Surg. 2024 Jun 21. doi: 10.1097/JS9.0000000000001852. Epub ahead of print. PMID: 38905504.
Comparing different remote access techniques, whether robotic or endoscopic, is challenging. However, analyzing large datasets can reveal trends that might be closer to the truth. In summary, after completing the learning curve, endoscopic techniques tend to be quicker, but robotic techniques may result in better outcomes overall.
Lechien JR, Hamdan AL, Fakhry N, Vaira LA, Iannella G, Gengler IM, Michel J, Radulesco T, Remacle M, Hans S, Cammaroto G, Saibene AM, Mayo-Yanez M, Maniaci A. Perception of Young European Otolaryngologists toward Transoral Robotic Surgery in Head and Neck Oncology and Surgery. J Clin Med. 2024 May 23;13(11):3055. doi: 10.3390/jcm13113055. PMID: 38892767; PMCID: PMC11172773.
I encountered some discrepancies during the publication process and scientific evaluation of this paper. However, now that it is published, let’s focus on the most relevant conclusion: we need to train our youngest colleagues in what will soon be standard practice.
Diaconescu A, Silver JA, Subramaniam T, Sewitch MJ, Mascarella MA, Ramirez-Garcia Luna J, Golabi N, Richardson K, Bouganim N, Forghani R, Marcin Mlynarek A, Hier MP, Sadeghi N. A Descriptive Study of Quality of Life Following Neoadjuvant Chemotherapy and Transoral Robotic Surgery for Human Papillomavirus-Associated Oropharyngeal Squamous Cell Carcinoma. J Otolaryngol Head Neck Surg. 2024 Jan-Dec;53:19160216241248670. doi: 10.1177/19160216241248670. PMID: 38888957; PMCID: PMC11155319.
I have already criticized this study in a letter to the editor (doi: 10.1001/jamaoto.2024.0479, PMID: 38602684) when it was recently published in JAMA Otolaryngol Head Neck Surg. I also wrote a post about it. Therefore, I will not insist on discussing the scientific content further. However, I must add an ethical critique regarding double publication, as it is essentially the same paper.
Awad L, Reed B, Bollen E, Langridge BJ, Jasionowska S, Butler PEM, Ponniah A. The emerging role of robotics in plastic and reconstructive surgery: a systematic review and meta-analysis. J Robot Surg. 2024 Jun 15;18(1):254. doi: 10.1007/s11701-024-01987-7. PMID: 38878229; PMCID: PMC11180031.
As expected with every new tool, the possibilities of use need to be explored, especially with a surgical tool as attractive as a robot. Every surgeon wants to be involved. More than ten years ago, there were already papers on robotic plastic and reconstructive surgery. Perhaps some are getting nervous that progress is not advancing as quickly as anticipated.
In my view, there is a basic misunderstanding. Current soft tissue robotic surgery is essentially endoscopic surgery. Previous endoscopic procedures have been “robotized,” advancing surgical possibilities. However, it is not a substitute for conventional open procedures, as every experienced surgeon knows. I am much better at performing a vascular micro-suture with my hands than I would ever be with the da Vinci system, even after more than ten years of performing robotic surgery.
This does not mean we won’t get there—probably sooner rather than later. My guess is that this will come with true robotization. For example, mechanical microvascular anastomosis will be robotized, and robots will surpass us in supermicrosurgery (the Symani Surgical System is still a tele-manipulated device).
Hyvrard C, Couineau F, Rigal T, Louerat S, Hans S, Baudouin R. Management of Parapharyngeal Metastatic Medullary Thyroid Carcinoma Via a Combined Trans-Cervical and Trans-Oral Robotic Approach. Ann Otol Rhinol Laryngol. 2024 Jun 14:34894241261630. doi: 10.1177/00034894241261630. Epub ahead of print. PMID: 38877727.
Tumors of the parapharyngeal space are an excellent indication for transoral robotic surgery. With a combined approach when required. The trans-mandibular approach and its consequences can be avoided in may in instances.
But here are a couple of pieces of advice based on experience. Be extremely careful with malignancies where achieving a free margin is crucial, and do not attempt a transoral approach to a deep lobe parotid pleomorphic adenoma unless you are reasonably sure you will not rupture it.
J Granell. June 22, 2024.
Head and Neck Robotic Surgery 