Clinical Report: Mitigating Hemorrhage and Surgical Risks in TORS

Overview

This international survey characterizes practice patterns in transoral robotic surgery (TORS) for oropharyngeal procedures, highlighting significant variability in management strategies. Key findings include the routine use of prophylactic neck vessel ligation and differences in postoperative care across subsites.

Background

Transoral robotic surgery (TORS) has transformed head and neck surgery by enabling minimally invasive techniques. However, the lack of standardized protocols for managing intraoperative and perioperative complications, particularly bleeding, presents variability in practice patterns.

Data Highlights

Key Findings

• 60% of surgeons routinely perform prophylactic neck vessel ligation for both base of tongue and lateral oropharyngectomy.
• Lingual artery ligation is significantly more frequent in base of tongue procedures compared to lateral oropharyngectomy (p < 0.001).
• Routine tracheotomy is uncommon, used in only 4-9% of cases, primarily for high-risk patients.
• Postoperative care varies, with most patients hospitalized for ≥4 days and 58-64% requiring nasogastric tubes.
• Local flap reconstruction is more common after lateral oropharyngectomy than after base of tongue resection.

Clinical Implications

Surgeons should be aware of the variability in TORS management practices.

Conclusion

The survey reveals significant variability in TORS practices.

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