Original Article

Evolution of neck dissections performed in conjunction with transoral robotic surgery lateral oropharyngectomy

Giri Krishnan, Rowan David, Michael Gouzos, Andrew Foreman, Suren Krishnan, John-Charles Hodge


Background: Two complications of transoral robotic surgery (TORS) lateral oropharyngectomy performed with neck dissection are hemorrhage and salivary leak. This study investigates the effect of neck dissection timing, and use of vessel ligation and muscle patch techniques, on the incidence of these complications.
Methods: A retrospective case review was conducted on 33 patients who underwent TORS lateral oropharyngectomy and ipsilateral neck dissection for tonsillar SCC in one tertiary medical center. A technique for vessel ligation and prophylactic orocervical repair is described.
Results: Eight patients (24%) underwent neck dissection prior to TORS, 19 patients (58%) had concurrent neck dissection with TORS, and six patients (18%) had a neck dissection following TORS. Of the 33 patients included, one had major haemorrhage and one developed a post-operative leak.
Conclusions: Neck dissection prior to TORS is feasible, enabling selective arterial ligation and digastric flap insertion, but further studies are required to confirm if this significantly reduces the incidence of major secondary haemorrhage and salivary leaks.

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