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In their view, the fundamental disagreement lies in the focus of the article, since they consider that the document criticising laryngeal robotic surgery is apparently a generalisation, “what should be being discussed is its essential usefulness in the oropharynx”.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Unfortunately, the editor considered this “partial” laryngeal view acceptable, and we only deal with the oropharynx superficially in our article. We would love to be able to review the subject of oropharyngeal robotic surgery and we will thus refer this suggestion to the Editorial Board. It is true that in the case of laryngeal oncology there are comparative series on both open surgery and transoral laser surgery, whilst in the case of robotic oropharyngeal surgery, where basically a transoral resection of the tumour is made with monopolar electro-dissection, there are insufficient comparisons with series on minimally invasive transoral approaches. The rapid transition in oropharyngeal oncology from open surgery with major morbidity to a transoral procedure with robotic electro-dissection, with apparently similar published results, is surprising. We would, in any case, repeat that our article focuses on laryngeal surgery, and their opinion that its usefulness in oropharyngeal tumours should be discussed is interesting and, therefore, also subject to systematic review.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Secondly, their argument regarding using the robot that is available on the premises is at the very least questionable, in the cost-restrictive environment in which we now find ourselves. An immediate counter-argument could be made, in other words, that the robot's availability might lead to overuse in order to justify or amortise its cost. In this regard, in a very recent review of robotic surgery on oropharyngeal and tongue cancer in the USA, it was stated that 25% of robotic procedures on the oropharynx were carried out for non oncological indications, the most frequent of which was tonsillectomy due to hypertrophy!<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> A very expensive piece of apparatus, with limited material and designed for other specialities, with, among other examples, astronomical annual maintenance contracts, an indefinite return value for when it needs to be updated, would require a value which compares extremely well with other alternatives in order to justify its use. Their affirmation that the cost of consumables for a TORS procedure (VAT included) is €1027.87 is demonstrably untrue: this does not include depreciation costs, maintenance costs; the total cost of consumables is undervalued, without engaging in further discussion on the useful lifetimes of each instrument or whether they have included other necessary investments such as the specific Feyh-Kastenbauer retractor which is basic to oropharyngeal surgery. It is highly significant that the use of the robot is being questioned for indications for which it was being used rapidly, based on financial criteria,<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">2,3</span></a> without dismissing the doubts which are being raised regarding its safety.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a> However, it is not just financial considerations which motivate us as surgeons: in our environment, with the very widespread use of CO2, the lack of publications or oral communications on laser stapedectomies or laser palatoplasties is surprising. Time will tell whether a technique offers little or nothing compared with other more “conventional” ones.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Thirdly, we fully agree that we should offer our patients the best possible treatment “avoiding media chatter and surgical fashions”. Regarding laryngeal surgery we are certain that at present there are equally effective alternatives to the robot which are also much faster and more economical. We are as yet unclear as to whether the robot offers any significant benefits for the oropharynx, since comparative literature is scarce and our speciality possesses great experience in non-robotic, minimally invasive, transoral approaches. As we expressed in our article, we believe that robotic surgery has great development potential for the base of the skull and we are working with it in this area in the experimental operating room and in the “operating theatre next door”.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Esteban F., Abrante A, Menoyo A. Respuesta al artículo «Ajustar el enfoque en cirugía robótica transoral». Acta Otorrinolaringol Esp. 2015;66:183–184.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0025" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transoral robotic surgery for oropharyngeal and tongue cancer in the United States" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "T.K. Chung" 1 => "E.L. Rosenthal" 2 => "J.S. Magnuson" 3 => "W.R. Carroll" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/lary.24870" "Revista" => array:6 [ "tituloSerie" => "Laryngoscope" "fecha" => "2015" "volumen" => "125" "paginaInicial" => "140" "paginaFinal" => "145" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25093603" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0030" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "New technology and health care costs. The case of robot-assisted surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G.I. Barbash" 1 => "S.A. Glied" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMp1006602" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2010" "volumen" => "363" "paginaInicial" => "701" "paginaFinal" => "704" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20818872" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0035" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Robotically assisted vs laparoscopic hysterectomy among women with benign gynecologic disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.D. Wright" 1 => "C.V. Ananth" 2 => "S.N. Lewin" 3 => "W.M. Burke" 4 => "Y.-S. Lu" 5 => "A.I. Neugut" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.2013.186" "Revista" => array:6 [ "tituloSerie" => "JAMA" "fecha" => "2013" "volumen" => "309" "paginaInicial" => "689" "paginaFinal" => "698" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23423414" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0040" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "FDA investigates robotic surgery system after adverse even spike" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R. Lowes" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "Medscape" "fecha" => "2013" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735735/0000006600000003/v1_201506160927/S2173573515000496/v1_201506160927/en/main.assets" "Apartado" => array:4 [ "identificador" => "5880" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letter to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735735/0000006600000003/v1_201506160927/S2173573515000496/v1_201506160927/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173573515000496?idApp=UINPBA00004N" ]
Journal Information
Vol. 66. Issue 3.
Pages 182-183 (May - June 2015)
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Vol. 66. Issue 3.
Pages 182-183 (May - June 2015)
Letter to the Editor
Reply to the Article “Adjusting the Focus of Transoral Robotic Surgery”
Respuesta al artículo “Ajustar el enfoque en cirugía robótica transoral”
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