Transoral robotic reconstruction of oropharyngeal defects: A case series

Background: Large resections of oropharyngeal tumors in the absence of a mandibulotomy create a reconstructive challenge, because flaps are often necessary, and inset requires contouring and suturing in a confined space with limited line of sight. Transoral robotically assisted reconstruction is the logical solution. Methods: The DaVinci Surgical System was used in five cases of oropharyngeal reconstruction. All oropharyngeal tumors were resected without a mandibulotomy, using either a transoral robotic approach or a lateral pharyngotomy. Robotic reconstruction was performed using a radial forearm, an anterolateral thigh flap, a facial artery myomucosal flap, and primary closure. The robot was also used to perform an arterial anastomosis. Results: All cases were performed with an intact mandible. This resulted in complex oropharyngeal defects with limited access. The robot was used to inset free flaps or local flaps, or to close primarily by improving access and precision in the oropharynx. The robot was used to perform a microvascular anastomosis between two, 2-mm arteries without hand-sewn revision. There were no surgical complications, flap failures, take-backs, or fistulas. All patients have been decannulated and are tolerating an oral diet without tube feeding. Conclusions: Minimally invasive resections provide locoregional control without the morbidity of mandibulotomy or high-dose chemoradiation. Transoral robotic reconstruction allows access and precision within the oropharynx. It is safe and effective, and may expand minimally invasive resections where reconstruction is not possible through traditional approaches.