Hemorrhage after Transoral Robotic Assisted Surgery

Abstract

Objective An increasing rate of head and neck surgeons have begun to utilize transoral robotic assisted surgery, as it is technically feasible and has acceptable safety levels. Our objective was to examine the postoperative bleeding complications we have encountered to determine risk factors and to discuss the topic of hemorrhage control. Method Medical records were reviewed in 147 consecutive patients undergoing transoral robotic assisted surgery for any indication at one tertiary academic medical center between March 2007 and September 2011. Results Eleven of 147 (7.5%) patients undergoing transoral robotic assisted surgery experienced some degree of postoperative hemorrhage, with 9 patients taken back to the operative room for examination and/or control of bleeding. Bleeding occurred at a mean of 11.1 days after the initial operation. Eight of 11 (72%) patients that bled were on antithrombotic medication (anticoagulants or antiplatelet agents) for other medical comorbidities. Postoperative hemorrhage in patients taking antithrombotic medication (8/48 patients = 17%) was significantly higher than in those not taking antithrombotics (3/99 patients = 3%), P =. 0057. There was no significant difference in patients undergoing primary (8/118 = 6.8%) or salvage (3/29 = 10.3%) surgery. Conclusion Potential for postoperative bleeding in association with antithrombotic medications in patients undergoing transoral robotic assisted surgery should be recognized. Indications for antithrombic medication in this patient population should be highly scrutinized and tightly regulated in the perioperative period.