Transcervical arterial ligation for prevention of <scp>postoperative</scp> hemorrhage in transoral oropharyngectomy: Systematic review and <scp>meta‐analysis</scp>

Sharbel, Daniel D.; Abkemeier, Mary; Sullivan, James; Zimmerman, Zach; Albergotti, William Greer; Duvvuri, Umamaheswar; Byrd, J. Kenneth

doi:10.1002/hed.26480

Cited by 14 publications

(5 citation statements)

References 36 publications

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“…Adequate control over vascular structures during robotic surgery is of paramount importance. In order to avoid catastrophic bleeding after TORS often ligation of the external carotid artery is recommended, 31 which however in the radiated neck would require an additional transcervical procedure. RESA for radiated patients performed through a submental incision provides readily access to Lesser's triangle at the level of the hypoglossal nerve.…”

Section: Discussionmentioning

confidence: 99%

The robotic‐assisted extended “Sistrunk” approach for tumors of the upper aerodigestive tract with limited transoral access: First description of oncological and functional outcomes

et al. 2022

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We report on the first clinical experience with the robotic-assisted extended "Sistrunk" approach (RESA) for access to constrained spaces of the upper aerodigestive tract. This prospective case cohort study include six patients that underwent RESA if transoral exposure could not be achieved. Three patients received previous radiation. Patients were postoperatively followed until week 16 for perioperative complications, surgical margins, and functional outcomes.In all patients RESA allowed adequate exposure and resection with negative margins. Three patients who underwent salvage surgery experienced a minor or intermediate grade postoperative bleeding. No patient developed a pharyngocutaneous fistula. Three patients recovered their swallowing to their preoperative status and the remaining three experienced an improvement. All patients experienced complete recovery of their voice. RESA has the potential to provide a new organ preservation approach for head and neck cancer (HNC) not amenable to transoral exposure and thus warrants further prospective clinical studies.

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Section: Discussionmentioning

confidence: 99%

The robotic‐assisted extended “Sistrunk” approach for tumors of the upper aerodigestive tract with limited transoral access: First description of oncological and functional outcomes

et al. 2022

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“…In a survey of TORS surgeons in 2013, there were a total of 6 (0.3%) perioperative mortalities out of 2015 cases, all due to postoperative bleeding 19 . More recently, prophylactic arterial ligation has been shown in multiple systematic reviews to be associated with a reduced risk of major and severe bleeding after TORS 20,21 …”

Section: Discussionmentioning

confidence: 99%

“…19 More recently, prophylactic arterial ligation has been shown in multiple systematic reviews to be associated with a reduced risk of major and severe bleeding after TORS. 20,21 Our study included a number of limitations. As with all studies involving national databases, selection bias, incomplete data, and coding errors limit its use.…”

Section: Discussionmentioning

confidence: 99%

Association of comorbidity score with perioperative outcomes following transoral robotic surgery: National analysis

2022

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Background The association of comorbidities with perioperative outcomes after transoral robotic surgery (TORS) is not well‐defined in the literature. Methods Using the National Cancer Database, 4004 patients with T1‐T2 oropharyngeal cancer between 2010 and 2017 were stratified based on their Charlson–Deyo Comorbidity Class (CDCC). Thirty‐day unplanned readmissions, 30‐day mortality, and 90‐day mortality were compared using chi‐square test and logistic regression. Hospital length of stay (LOS) was compared using the Kruskal–Wallis test. Results LOS was greater for patients with CDCC 2 or 3 compared to CDCC 0 or 1 (p < 0.001). Increasing age and CDCC ≥3 were associated with 30‐day mortality (CDCC ≥3: odds ratio [OR] 5.55, 95% confidence interval [CI] 1.59–19.45). CDCC ≥3 (OR 2.61, 95%CI 1.09–6.27) was significantly associated with 30‐day readmissions. Conclusion This national analysis demonstrates greater rates of unplanned 30‐day readmissions, longer hospitalizations, and increased 30‐ and 90‐day mortality after TORS in patients with CDCC ≥3.

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“…Continuous variables were compared using appropriate effect-size measures (Cohen test with 95% CIs). Analysis is reported in the eAppendix in Supplement 1 …”

Section: Methodsmentioning

confidence: 99%

Comparison of da Vinci Single Port vs Si Systems for Transoral Robotic-Assisted Surgery

Oberhelman,

Bruening,

Jackson

et al. 2024

JAMA Otolaryngol Head Neck Surg

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ImportanceTransoral robot-assisted surgery (TORS) continues to have a major role in the treatment of oropharyngeal cancer. As new iterations of robotic technology are increasingly utilized, it is important to share learning experiences and clinical outcomes data, to optimize technical efficiency and clinical care.ObservationsThis was a retrospective review of a large academic institution’s initial clinical use of the da Vinci Single Port (SP) compared with the da Vinci Si (Si) system. A total of 205 TORS cases were reviewed: 109 in the SP group (November 22, 2018, through September 30, 2020), and 96 in the Si group (January 1, 2016, through November 12, 2018). Both groups had comparable operative times, rates of postoperative pharyngeal hemorrhage, length of hospital stay, and duration of nasogastric feeding tube use. There was no difference in pathological characteristics, rates of positive margins, or indications for or time to initiation of adjuvant therapy between the groups. The collective experience of 6 faculty members—who have trained 139 TORS surgeons for the SP system rollout—was compiled to provide a summary of learning experiences and technical notes on safe and efficient operation of the SP system.Conclusions and RelevanceThis Review found that the functional and oncologic outcomes were comparable between TORS cases performed with the Si and SP systems, and they had similar complication rates. Recognized advantages of the SP over the Si system include the availability of bipolar-energized instruments, a usable third surgical arm, and improved camera image quality.

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Transcervical arterial ligation for prevention of postoperative hemorrhage in transoral oropharyngectomy: Systematic review and meta‐analysis

Cited by 14 publications

References 36 publications

The robotic‐assisted extended “Sistrunk” approach for tumors of the upper aerodigestive tract with limited transoral access: First description of oncological and functional outcomes

The robotic‐assisted extended “Sistrunk” approach for tumors of the upper aerodigestive tract with limited transoral access: First description of oncological and functional outcomes

Association of comorbidity score with perioperative outcomes following transoral robotic surgery: National analysis

Comparison of da Vinci Single Port vs Si Systems for Transoral Robotic-Assisted Surgery

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