Related Experiment Video
Updated: Mar 7, 2026

Identification and Protection of the Recurrent Laryngeal Nerve during Transoral Robotic Thyroidectomy
Published on: October 24, 2025
Temporary tracheotomy in transoral robotic surgery (TORS): from a retrospective single-center analysis to a proposal
Luigi Marco Stringa1, Giuseppe Meccariello2, Giovanni Cammaroto2
1Otolaryngology-Head and Neck Surgery Department, AP-HP, Hôpital Tenon, Sorbonne University, Paris, 75020, France. luigi.stringa@gmail.com.
Purpose:
To propose a decision-making algorithm for preventive tracheostomy in patients with obstructive sleep apnea syndrome (OSAS) or oropharyngeal squamous cell carcinoma (OPSCC) undergoing transoral robotic surgery (TORS).
Methods:
Preoperative assessment integrated clinical history with anesthesiologic scoring systems, including the ASA classification, El-Ganzouri Risk Index (EGRI), and STOP-Bang questionnaire. Additional pro-hemorrhagic factors were also considered. Based on individual risk profiles, tracheostomy was performed before or after TORS when indicated.
Results:
Higher ASA and EGRI scores, coagulopathy, cardiovascular disease, hypertension, and smoking were significantly associated with increased rates of tracheostomy and postoperative bleeding.
Conclusions:
Preventive tracheostomy during TORS should be considered according to the surgical plan and the patient's overall clinical condition, particularly in cases of severe OSAS, BMI > 27.5, elevated EGRI or ASA scores, anticoagulant therapy, coagulopathy, cardiovascular comorbidities, and active smoking or alcohol consumption.
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