{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T12:30:48Z","timestamp":1791549048841,"version":"4.3.4"},"reference-count":40,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2020,2,28]],"date-time":"2020-02-28T00:00:00Z","timestamp":1582848000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Postoperative hemorrhage is the most common complication of transoral robotic surgery (TORS), the severity of which can range from minor bleeding treated with observation to catastrophic hemorrhage leading to death. To date, little is known about the incidence, risk factors, and management of post\u2010TORS hemorrhage.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>Systematic Review and Metanlysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic review of the published literature using the Cochrane Handbook for Systematic Reviews of Interventions was performed and examined TORS, postoperative hemorrhage, and the use of prophylactic transcervical arterial ligation (TAL).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 13 articles were included in the analysis. To date, there have been 332 cases of hemorrhage following a total of 5748 TORS. The pooled median post\u2010TORS hemorrhage rate was 6.47%. The overall incidence of minor and major hemorrhage was 5.29% and 2.90%. Patients with prior radiation (relative risk [RR] =\u20091.46, 95% confidence interval [CI] =\u20091.00\u20132.12), large tumors (RR = 2.11, 95% CI = 1.48\u20132.99), and those requiring perioperative coagulation (RR = 2.25, 95% CI = 1.54\u20133.28) had significantly higher relative risks of hemorrhage. There was no significant difference in the relative risk of overall hemorrhage with TAL. Looking at major hemorrhage, patients undergoing TAL had a large but insignificant relative risk reduction in post\u2010TORS hemorrhage (RR = 0.40, 95% CI = 0.15\u20131.07).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The incidence of post\u2010TORS hemorrhage is low (5.78%), and for major hemorrhage requiring emergent embolization, TAL, or tracheotomy to control hemorrhage it is even lower (2.90%). Large tumors, perioperative anticoagulation, and prior radiation were associated with significantly increased risk of post\u2010TORS hemorrhage. TAL does not reduce the overall incidence of post\u2010TORS hemorrhage but may lead to fewer severe hemorrhages.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>\n                      III\n                      <jats:italic>Laryngoscope<\/jats:italic>\n                      , 131:95\u2013105, 2021\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/lary.28580","type":"journal-article","created":{"date-parts":[[2020,2,28]],"date-time":"2020-02-28T09:20:17Z","timestamp":1582881617000},"page":"95-105","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":101,"title":["Bleeding Complications After Transoral Robotic Surgery: A Meta\u2010Analysis and Systematic Review"],"prefix":"10.1002","volume":"131","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8087-6552","authenticated-orcid":false,"given":"William","family":"Stokes","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery West Virginia University Health Sciences Center  Morgantown West Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jad","family":"Ramadan","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery West Virginia University Health Sciences Center  Morgantown West Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georges","family":"Lawson","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Universit\u00e9 Catholique de Louvain Centre Hospitalier Universitaire de Mont\u2010Godinne  Yvoir Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F. Robert L.","family":"Ferris","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery University of Pittsburgh Medical Center  Pittsburgh Pennsylvania"},{"name":"Department of Immunology University of Pittsburgh  Pittsburgh Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9594-1414","authenticated-orcid":false,"given":"Floyd Christopher","family":"Holsinger","sequence":"additional","affiliation":[{"name":"Division of Head and Neck Surgery, Department of Otolaryngology\u2010Head and Neck Surgery Stanford University Medical Center  Palo Alto California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8621-6168","authenticated-orcid":false,"given":"Meghan T.","family":"Turner","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery West Virginia University Health Sciences Center  Morgantown West Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,2,28]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1200\/JOP.2016.015263"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2013.5097"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.24677"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/coa.13041"},{"key":"e_1_2_6_6_1","unstructured":"Eastern Cooperative Oncology Group; National Cancer Institute (NCI). 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