Oropharyngeal Free Flap Inset With a Single Port Robot: A Case Series

INTRODUCTION: Traditional oropharyngeal resection may require lip-split mandibulotomy approach (LSMA) which risks high morbidity. Transoral robotic surgery (TORS) through the oral pharynx mitigates these risks. Free flap (FF) inset following resection is challenging and may require open approaches, negating the benefits of TORS resection. We present our case series utilizing the single port (SP) robot for FF inset, which has improved visualization and functionality compared with a multiport robot. METHODS: A retrospective review of robotic FF inset following TORS using the SP from 2021 to 2022. Patient and tumor characteristics as well as operative and postoperative details were gathered. RESULTS: Five cases were performed with an average age of 62.4 (50-78) years. Radial forearm FF was used in three cases and anterolateral thigh flap in two. Mean operative time was 528 (423-742) minutes with an average ischemia time of 156.6 (124-198) min. Average functional oral intake score was 5.8 (3-7) out of 7. There were no FF losses or wound healing issues at an average of 17.6 (7-27) months follow-up. CONCLUSION: Robotic FF inset following TORS is feasible with the SP robot already used by ENTs for resection. The platform has 6 mm instruments capable of 7 degrees of freedom, use of a third arm for dynamic retraction, and the ability to assume a "cobra-like" position to leverage a tight space. This gives plastic surgeons an opportunity to decrease the complication profile from FF inset that would otherwise require potentially morbid exposures.

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A retrospective series of five patients undergoing single-port robotic free flap inset after transoral robotic oropharyngeal resection found no flap losses or wound-healing problems at a mean follow-up of 17.6 months, with mean operative time 528 minutes.

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