Analysis of post-transoral robotic-assisted surgery hemorrhage: Frequency, outcomes, and prevention.
Transoral robotic-assisted surgery (TORS) carries a small, but not insignificant, risk of life-threatening postsurgical hemorrhage. The purpose of this study was to analyze all post-TORS hemorrhagic events at our institution to establish preventative recommendations.



We conducted a retrospective review of 224 consecutive patients who underwent TORS for any indication at a single tertiary care institution.



Twenty-two patients (n = 22; 9.82%) had varying degrees of postoperative bleeding. An impaired ability to protect the airway at the time of hemorrhage increased the rate of severe complications. Prophylactic transcervical arterial ligation did not significantly decrease overall postoperative bleeding rates (9.1% vs 9.9%; p = 1.00); however, there was a trend toward decreased hemorrhage severity in prophylactically ligated patients (3.0% vs 7.3%; p = .7040).



Prophylactic transcervical arterial ligation may reduce the incidence of severe bleeding following TORS. Post-TORS patients displaying an inability to protect the airway should be strongly considered for prophylactic tracheostomy to assist airway protection. © 2015 Wiley Periodicals, Inc. Head Neck 38: E776-E782, 2016.
Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Rajarsi
R
Mandal
Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.|Veterans Affairs Pittsburgh Health System, Pittsburgh, Pennsylvania.
Umamaheswar
U
Duvvuri
Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Robert L
RL
Ferris
University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
Thomas M
TM
Kaffenberger
Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Garret W
GW
Choby
Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Seungwon
S
Kim
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D019647:Oral Surgical Procedures / Q000009:adverse effects*; D019106:Postoperative Hemorrhage / Q000453:epidemiology*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000009:adverse effects*; D014139:Tracheostomy; D055815:Young Adult
TORS bleeding; TORS complications; TORS hemorrhage; prophylactic arterial ligation; transoral robotic-assisted surgery (TORS)