Reconstruction of TORS oropharyngectomy defects with the nasoseptal flap via transpalatal tunnel

Turner, Meghan; Geltzeiler, Mathew; Albergotti, William Greer; Duvvuri, Umamaheswar; Ferris, Robert L.; Kim, Seungwon; Wang, Eric

doi:10.1007/s11701-019-00984-5

Cited by 8 publications

(18 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…One might also give more thought to reconstruction as opposed to healing by secondary intention, which eliminates minor hemorrhage from the granulating wound. [27][28][29][30] Additionally, the incidence of post-TORS hemorrhage was significantly higher in patients undergoing surgery for large primary tumors. Whereas only a small subset of patients undergoing TORS have large tumors, patients with large tumors had a bleeding incidence that was nearly twice as high as small tumors (13.8% vs. 7.9%).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Bleeding Complications After Transoral Robotic Surgery: A Meta‐Analysis and Systematic Review

et al. 2020

Self Cite

View full text Add to dashboard Cite

Objective Postoperative hemorrhage is the most common complication of transoral robotic surgery (TORS), the severity of which can range from minor bleeding treated with observation to catastrophic hemorrhage leading to death. To date, little is known about the incidence, risk factors, and management of post‐TORS hemorrhage. Study Design Systematic Review and Metanlysis. Methods A systematic review of the published literature using the Cochrane Handbook for Systematic Reviews of Interventions was performed and examined TORS, postoperative hemorrhage, and the use of prophylactic transcervical arterial ligation (TAL). Results A total of 13 articles were included in the analysis. To date, there have been 332 cases of hemorrhage following a total of 5748 TORS. The pooled median post‐TORS hemorrhage rate was 6.47%. The overall incidence of minor and major hemorrhage was 5.29% and 2.90%. Patients with prior radiation (relative risk [RR] = 1.46, 95% confidence interval [CI] = 1.00–2.12), large tumors (RR = 2.11, 95% CI = 1.48–2.99), and those requiring perioperative coagulation (RR = 2.25, 95% CI = 1.54–3.28) had significantly higher relative risks of hemorrhage. There was no significant difference in the relative risk of overall hemorrhage with TAL. Looking at major hemorrhage, patients undergoing TAL had a large but insignificant relative risk reduction in post‐TORS hemorrhage (RR = 0.40, 95% CI = 0.15–1.07). Conclusion The incidence of post‐TORS hemorrhage is low (5.78%), and for major hemorrhage requiring emergent embolization, TAL, or tracheotomy to control hemorrhage it is even lower (2.90%). Large tumors, perioperative anticoagulation, and prior radiation were associated with significantly increased risk of post‐TORS hemorrhage. TAL does not reduce the overall incidence of post‐TORS hemorrhage but may lead to fewer severe hemorrhages. Level of Evidence III Laryngoscope, 131:95–105, 2021

show abstract

Section: Discussionmentioning

confidence: 99%

“…If anticoagulation is medically necessary, the surgeon might consider TAL during neck dissection. One might also give more thought to reconstruction as opposed to healing by secondary intention, which eliminates minor hemorrhage from the granulating wound 27–30 …”

Section: Discussionmentioning

confidence: 99%

Bleeding Complications After Transoral Robotic Surgery: A Meta‐Analysis and Systematic Review

et al. 2020

Self Cite

View full text Add to dashboard Cite

show abstract

“…Furthermore, known innovative tissue reconstruction techniques may benefit from the application of TORS. One study describes the TORS-based reconstruction of a tissue defect after lateral oropharynx resection and radical tumor tonsillectomy with a naso-septal flap being pulled through a transpalatal tunnel [ 16 ].…”

Section: Resultsmentioning

confidence: 99%

Current Advances in Robotics for Head and Neck Surgery—A Systematic Review

Böhm¹,

Graesslin²,

Theodoraki³

et al. 2021

Cancers

View full text Add to dashboard Cite

Background. In the past few years, surgical robots have recently entered the medical field, particularly in urology, gynecology, and general surgery. However, the clinical effectiveness and safety of robot-assisted surgery (RAS) in the field of head and neck surgery has not been clearly established. In this review, we evaluate to what extent RAS can potentially be applied in head and neck surgery, in which fields it is already daily routine and what advantages can be seen in comparison to conventional surgery. Data sources. For this purpose, we conducted a systematic review of trials published between 2000 and 2021, as well as currently ongoing trials registered in clinicaltrials.gov. The results were structured according to anatomical regions, for the topics “Costs,” “current clinical trials,” and “robotic research” we added separate sections for the sake of clarity. Results. Our findings show a lack of large-scale systematic randomized trials on the use of robots in head and neck surgery. Most studies include small case series or lack a control arm which enables a comparison with established standard procedures. Conclusion. The question of financial reimbursement is still not answered and the systems on the market still require some specific improvements for the use in head and neck surgery.

show abstract

“…This compares to an average of 338 min of total operative time in the cases we describe. Regional flaps, including the temporalis muscle 19 and nasoseptal flaps, 20,21 have similarly been described for oropharyngeal reconstruction after TORS. To our knowledge, using the above described search terms, this represents the first description of the SAIF for robotic‐assisted oropharyngeal reconstruction.…”

Section: Discussionmentioning

confidence: 99%

Transoral robotic salvage oropharyngectomy with submental artery island flap reconstruction

Holcomb

Richmon

2020

Head & Neck

View full text Add to dashboard Cite

Background: Transoral robotic surgery (TORS) is an effective approach for select salvage oropharyngeal resections. Reconstruction in these scenarios is often necessary for vascular coverage and optimal functional outcomes but can be challenging. The submental artery island flap (SAIF) is well-suited to this reconstruction. Design/Method: Two patients presented with recurrent oropharyngeal tumors after chemoradiation. Each tumor was resected using TORS, and the SAIF was utilized for reconstruction. Flap inset was completed using TORS in one case. Results: Both patients experienced uneventful recovery free from bleeding events or fistula formation and experienced no partial flap loss or donor site complications. Conclusions: The SAIF is a simple reconstructive option for TORS defects that may be inset using robotic assistance and avoids the need for free tissue transfer.

show abstract

Reconstruction of TORS oropharyngectomy defects with the nasoseptal flap via transpalatal tunnel

Cited by 8 publications

References 20 publications

Bleeding Complications After Transoral Robotic Surgery: A Meta‐Analysis and Systematic Review

Bleeding Complications After Transoral Robotic Surgery: A Meta‐Analysis and Systematic Review

Current Advances in Robotics for Head and Neck Surgery—A Systematic Review

Transoral robotic salvage oropharyngectomy with submental artery island flap reconstruction

Contact Info

Product

Resources

About