Reconstruction after robotic head and neck surgery: when and why

Area of Science:

• Surgical Oncology
• Robotic Surgery
• Head and Neck Surgery

Background:

• Robotically assisted surgery has revolutionized oncologic resection, aiming to reduce patient morbidity without compromising outcomes.
• Transoral robotic surgery (TORS) is a key advancement, enabling organ-preserving resection of head and neck tumors via the da Vinci surgical system.
• TORS facilitates tumor removal without external incisions, potentially sparing patients adjuvant treatments and improving upon traditional transoral techniques.

Purpose of the Study:

• To review the current literature on TORS reconstruction in head and neck cancer surgery.
• To focus on patient selection, tumor size, and location as critical factors for reconstruction.
• To propose an algorithmic approach for determining the necessity of robotic-assisted reconstruction after TORS.

Main Methods:

• Comprehensive review of existing literature pertaining to TORS reconstruction.
• Analysis of patient selection criteria, tumor characteristics (size and location), and prior treatments.
• Inclusion of the authors' experience with 20 TORS procedures involving robotic-assisted reconstructions.

Main Results:

• The literature thus far has primarily focused on the feasibility, safety, and implementation of robotic assistance in TORS reconstruction.
• Clear guidelines for when reconstruction is warranted after TORS are currently lacking.
• The authors' experience and literature review inform an algorithmic approach based on tumor factors and patient specifics.

Conclusions:

• As TORS is increasingly used for larger tumors, robotic-assisted reconstruction is becoming a crucial part of the surgical paradigm.
• An algorithmic approach considering tumor location, extent, prior treatment, and patient-specific factors can guide reconstruction decisions.
• Further research and guideline development are needed to standardize the application of robotic-assisted reconstruction in TORS.