Second postoperative hemorrhage five weeks after transoral robotic surgery |
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| Institution: | 1. Department of Otolaryngology-Head and Neck Surgery,The Second Affiliated Hospital of Harbin Medical University, Haerbin,China;2. Department of Otolaryngology-Head and Neck Surgery,Yantai Yuhuangding Hospital,Yantai,China;1. Department of Otorhinolaryngology & Head and Neck Surgery, Tokyo Medical University;2. Department of Neurosurgery, Tokyo Medical University;1. Department of Otolaryngology-Head and Neck Surgery, Nara Medical University, Nara, Japan;2. Department of Otolaryngology-Head and Neck Surgery, Nippon Life Hospital, Osaka, Japan;3. Department of Otolaryngology, Takai Hospital, Nara, Japan;1. Department of Plastic and Reconstructive Surgery, Kyushu University Hospital, Japan;2. Department of Otorhinolaryngology and Head and Neck Surgery, Sasebo Kyosai Hospital, Japan;1. HNO-Zentrum Rhein-Neckar, Mannheim, Germany;2. University hospital Mannheim, Department of Otorhinolaryngology, Mannheim, Germany;3. SLK-Kliniken Heilbronn, Department of Otorhinolaryngology, Klinikum am Gesundbrunnen, Heilbronn, Germany;4. University hospital Heidelberg, Department of Otorhinolaryngology, Heidelberg, Germany |
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| Abstract: | Transoral robotic surgery (TORS) is becoming widely used in Japan, and information on postoperative hemorrhage is needed. We treated a patient who developed a second massive postoperative hemorrhage on Day 35 post-TORS. The 69-year-old man was diagnosed with p16-positive, T1N1M0 stage I cancer of the anterior wall of the oropharynx. Curative treatment began with right neck dissection. The external carotid artery and its branches were not ligated. One month after right neck dissection, TORS was conducted. On Day 23 post-TORS, the patient was brought to the emergency room due to pharyngeal bleeding. Hemorrhage was stopped by reclosing the site with Z-shaped silk sutures. Severe hemorrhage recurred on Day 35 post-TORS. The patient went into hemorrhagic shock. Tracheostomy was immediately performed. The neck dissection wound was then opened and the external carotid artery clamped. Hemostasis was confirmed transorally, but the hemorrhage site was again sutured with Z-shaped silk sutures to stop the bleeding. The patient was discharged on Day 58 post-TORS. Even in hindsight, this hemorrhage would have been difficult to prevent with better local treatment. This means that using transcervical arterial ligation together with TORS is appropriate from the perspective of making every effort to prevent potentially fatal postoperative hemorrhage. |
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