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THE KILL PATROL VOLUME 1 2. Cade: A life of Harry S. Ashlyn: Dirty.Transnasal versus transoral robotic assisted surgical approaches in the treatment of Zenker’s diverticulum.
The treatment of Zenker’s diverticulum (ZD) by transoral robotic assisted surgery (TORS) has significant benefits in terms of shorter hospitalization and it does not involve any sutures that may cause stenosis of the esophagus. On the contrary, patients with ZD must wait in the post-anesthesia care unit (PACU) for several hours, which may be inconvenient and can even have a negative impact on patient compliance and quality of life. To compare the feasibility, safety and efficacy of the transnasal robotic assisted surgical approach (TRA) with the TORS in the treatment of ZD. The paper also aims to outline the applicability of the TRA in treating patients with benign and malignant head and neck pathologies with poor accessibility to the oral cavity, whose treatment might require a more complete surgical intervention. Nineteen patients with ZD (Type III and IV according to Thalhammer-Mann classification) underwent robotic surgery. The patients were divided into two groups: group A (TRA) and group B (TORS). In Group A, 12 patients underwent the TRA and in Group B, 7 underwent the TORS. Pre-operative clinical and endoscopic examination confirmed the diagnosis of ZD in all patients. All patients were treated by the same surgical team using the da Vinci S robot and a 3-arm Da Vinci surgical approach for both the TRA and the TORS. All patients were monitored for perioperative complications (postoperative dysphagia, anastomotic strictures, pain), postoperative results, and complications at the one year follow-up visit. There were no significant differences in the demographic or surgical data between the two groups. Four (33%) patients in the TRA group and 1 (14%) patient in the TORS group (p=0.32) presented with hoarseness. In the TORS group, 1 patient (14%) developed postoperative stricture at the level of the anastomosis. In the TRA group, 1 patient (11%) developed postoperative stricture (p=0.67). Two patients (17%) in the TRA group required a revision surgery. No significant differences were recorded in the overall time to resume normal diet and in the overall hospital stay (p=0
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