With extensive instrumentation near the face and eyes, concerns have also been raised regarding patient safety. Hockstein et al. performed a cadaveric study, early in the development of TORS, examining the safety profile of robotic instrumentation as compared to traditional transoral tools and found that few additional risks were accrued by using the robot.26 However, this technical question about TORS still requires more time and investigation. Figure 1. Robotic Instrumentation Set-up during Transoral Robotic Procedure. Experienced surgeons also comment that the lack of Inhibitors,research,lifescience,medical tactile

feedback is an important concern when using robotic instruments and can lead to mishandling of delicate tissues.24 This contributes to the significant learning curve associated with utilizing the robot. Length of time that a patient is intubated, operative time, and technical complications such as bleeding have been shown to be increased early Inhibitors,research,lifescience,medical in a surgeon’s learning curve with TORS. However, these factors decrease significantly with surgeon experience.28 Consequently, reported outcomes for TORS may

unfavorably vary from actual outcomes in certain circumstances. It is important Inhibitors,research,lifescience,medical to consider some of these factors before adopting TORS in practice. TORS FOR HPV-RELATED CANCERS Oropharyngeal cancer that is related to HPV infection differs from non-HPV-related oropharyngeal cancer in a number of ways. Patients affected by HPV-related cancers are typically younger at diagnosis and also more likely

to be never-smokers and never-drinkers. Three-year survival Inhibitors,research,lifescience,medical rates have also been shown to be better for HPV-related cancers (82% versus 57% in HPV-negative patients).2 As such, it is important to consider that optimal Everolimus management of HPV-related tumors may also need to be different from non-HPV-related tumors. More specifically, these younger patients with improved prognoses may be Inhibitors,research,lifescience,medical good candidates for minimally invasive, function-sparing techniques such as TORS. In 2010, Cohen and colleagues established that despite differences in prognosis and outcomes between HPV-positive and HPV-negative oropharyngeal cancers, TORS is effective as a primary treatment modality in both subsets of patients. In their review of 50 patients with oropharyngeal cancer managed with primary TORS, there was no statistically significant difference in disease-specific survival based on HPV PD184352 (CI-1040) status.29 On the other hand, some studies have suggested that HPV status has a significant impact on the effectiveness of TORS in treating oropharyngeal cancer. It has been suggested that TORS alone, without adjuvant therapy, may be adequate treatment for HPV-positive oropharyngeal cancer. Recently, Olsen et al. reported a study of 18 patients with T1–T3 oropharyngeal tumors with N0–N2a neck disease who underwent surgery alone (TORS with neck dissection) and no adjunct therapy.