Reconstruction with free flaps in robotic head-and-neck onco-surgeries

ABSTRACT

Aims and Objective: The aim of the present article is to highlight how reconstruction with free flaps is different and difficult in cases with robotic head-and-neck cancer surgery. It also highlights the technical guidelines on how to manage the difficulties. Materials and Methods: Eleven patients with oropharyngeal cancer having undergone tumour excision followed by free-flap reconstruction been reviewed here. Nine patients had tumour excision done robotically through intraoral route while neck dissection done with transverse neck crease incision. There is a problem of difficult flap inset in this group of patient. Two patients had intraoral excision of tumour followed by robotic neck dissection via retroauricular incision. With no incision directly on the neck, microvascular anastomosis is challenging in this set of patients. Free flap was used in all the cases to reconstruct the defect. Results: Successful reconstruction with free flap was done in all the cases with good outcome both functionally and aesthetically. Conclusion: Free-flap reconstruction is possible in robotic head-and-neck cancer surgery despite small and difficult access, but it does need practice and some technical modifications for good outcome.

KEY WORDS

Free flap - head-and-neck cancer - robotic free flap - robotic head-and-neck cancer surgery - robotic head-and-neck reconstruction - transoral robotic surgery

• REFERENCES

• 1 Bhayani MK, Holsinger FC, Lai SY. A shifting paradigm for patients with head and neck cancer: Transoral robotic surgery (TORS). Oncology (Williston Park) 2010; 24: 1010-5
• 2 Weinstein GS, O'Malley Jr. BW, Cohen MA, Quon H. Transoral robotic surgery for advanced oropharyngeal carcinoma. Arch Otolaryngol Head Neck Surg 2010; 136: 1079-85
• 3 Bonawitz SC, Duvvuri U. Robot-assisted oropharyngeal reconstruction with free tissue transfer. J Reconstr Microsurg 2012; 28: 485-90
• 4 Dziegielewski PT, Mlynarek AM, Dimitry J, Harris JR, Seikaly H. The mandibulotomy: Friend or foe? Safety outcomes and literature review. Laryngoscope 2009; 119: 2369-75
• 5 Leonhardt FD, Quon H, Abrahão M, O'Malley Jr. BW, Weinstein GS. Transoral robotic surgery for oropharyngeal carcinoma and its impact on patient-reported quality of life and function. Head Neck 2012; 34: 146-54
• 6 Park YM, Holsinger FC, Kim WS, Park SC, Lee EJ, Choi EC. et al. Robot-assisted selective neck dissection of levels II to V via a modified facelift or retroauricular approach. Otolaryngol Head Neck Surg 2013; 148: 778-85
• 7 Biron VL, O'Connell DA, Barber B, Clark JM, Andrews C, Jeffery CC. et al. Transoral robotic surgery with radial forearm free flap reconstruction: Case control analysis. J Otolaryngol Head Neck Surg 2017; 46: 20
• 8 Song HG, Yun IS, Lee WJ, Lew DH, Rah DK. Robot-assisted free flap in head and neck reconstruction. Arch Plast Surg 2013; 40: 353-8