title: Robot-assisted free flap in head and neck reconstruction.
abstract: BACKGROUND
  Robots have allowed head and neck surgeons to extirpate oropharyngeal tumors safely without the need for lip-split incision or mandibulotomy. Using robots in oropharyngeal reconstruction is new but essential for oropharyngeal defects that result from robotic tumor excision. We report our experience with robotic free-flap reconstruction of head and neck defects to exemplify the necessity for robotic reconstruction.
  
  
  METHODS
  We investigated head and neck cancer patients who underwent ablation surgery and free-flap reconstruction by robot. Between July 1, 2011 and March 31, 2012, 5 cases were performed and patient demographics, location of tumor, pathologic stage, reconstruction methods, flap size, recipient vessel, necessary pedicle length, and operation time were investigated.
  
  
  RESULTS
  Among five free-flap reconstructions, four were radial forearm free flaps and one was an anterolateral thigh free-flap. Four flaps used the superior thyroid artery and one flap used a facial artery as the recipient vessel. The average pedicle length was 8.8 cm. Flap insetting and microanastomosis were achieved using a specially manufactured robotic instrument. The total operation time was 1,041.0 minutes (range, 814 to 1,132 minutes), and complications including flap necrosis, hematoma, and wound dehiscence did not occur.
  
  
  CONCLUSIONS
  This study demonstrates the clinically applicable use of robots in oropharyngeal reconstruction, especially using a free flap. A robot can assist the operator in insetting the flap at a deep portion of the oropharynx without the need to perform a traditional mandibulotomy. Robot-assisted reconstruction may substitute for existing surgical methods and is accepted as the most up-to-date method.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Han Gyeol
authors.initials: HG
authors.lastname: Song
authors.forename: In Sik
authors.initials: IS
authors.lastname: Yun
authors.forename: Won Jai
authors.initials: WJ
authors.lastname: Lee
authors.forename: Dae Hyun
authors.initials: DH
authors.lastname: Lew
authors.forename: Dong Kyun
authors.initials: DK
authors.lastname: Rah
keywords: Free tissue flaps; Head and neck neoplasms; Robotics
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