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2011 Annual Meeting Abstracts

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Trans-Oral Robotic Reconstruction of Oropharyngeal Defects
Jesse C. Selber, MD, MPH, Geoff Robb, MD.
M,D, Anderson Cancer Center, Houston, TX, USA.

Large resections of oropharyngeal tumors in the absence of a mandibulotomy create a reconstructive challenge. Flaps are often necessary, and inset requires contouring and suturing in a confined space with limited line of site, deep within the oropharynx. Trans-oral robotically assisted reconstruction allows access to these deep structures, providing visualization and precision.
The DaVinci Surgical System was used in 10 cases of oropharyngeal reconstruction. All oropharyngeal tumors were resected without a mandibulotomy, using either a transoral robotic approach or a lateral pharyngotomy and pull-through. Robotic reconstruction was performed using 2 radial forearm flaps, 4 anterolateral thigh flaps, 2 facial artery myomucosal flaps and and 2 pharyngeal flaps. The robot was used for insetting of the flap, as well as to perform arterial anastomoses.
All cases were performed with an intact mandible. These resulted in complex, oropharyngeal defects with limited access. The robot was used to inset free flaps and local flaps by improving access and precision in the oropharynx. The robot was used to perform microvascular anastomoses in the neck without any additional, hand-thrown sutures. There were no surgical complications, flap failures, take-backs or fistulas. All patients have been decannluated, and are tolerating an oral diet without tube feeds.
Minimally invasive resections provide locoregional control without the morbidity of mandibulotomies or high dose chemoradiation. Trans-oral robotic reconstruction allows access and precision within the oropharynx. The robot is also well-suited to accomplish the microvascular anastomosis. It is safe and effective, and may expand minimally invasive resections where reconstruction is not possible through traditional approaches.

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