Abstract
The advancement of robotically assisted surgery during the last decade has seen a
revolution in the approach to surgical oncologic resection, moving toward reducing
patient morbidity without compromising oncologic outcomes. In no field has this been
more dramatic than in the application of transoral robotic surgery (TORS), using the
da Vinci surgical system for resecting tumors of the head and neck. This organ-preserving
technique allows the surgeon to remove tumors of the upper aerodigestive tract without
external incisions and potentially spare the patient adjuvant treatment. The introduction
of TORS improves upon current transoral techniques to the oropharynx and supraglottis.
The traditional conception of TORS is that it would be used for smaller tumors and
defects would be permitted to heal by secondary intention; however, as head and neck
surgeons pursue larger tumors robotically, robotic-assisted reconstruction has entered
the paradigm. Given the relative infancy of these procedures, clear guidelines for
when reconstruction is warranted do not exist. The current literature, thus far, has
focused on feasibility, safety, and implement of the robot in reconstruction. We reviewed
the current literature pertinent to TORS reconstruction focusing on patient selection,
tumor size, and location. Furthermore, we briefly review our own experience of 20
TORS procedures involving robotic-assisted reconstructions. Finally, we provide an
algorithmic approach to determining the need for reconstruction in a given patient.
This focuses on four key criteria: tumor location, tumor extent, prior treatment,
and patient-specific factors.
Keywords
robotic reconstruction - da Vinci - tors
