{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T05:02:02Z","timestamp":1784523722888,"version":"3.55.0"},"reference-count":22,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T00:00:00Z","timestamp":1784505600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to characterize global practice patterns in transoral robotic surgery (TORS), with particular attention to differences across oropharyngeal subsites.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a 40-item international web-based survey of TORS-experienced head and neck surgeons (April\u2013June 2024). The questionnaire covered demographics, robotic platforms, bleeding prevention, airway management, postoperative care, and reconstruction. Descriptive statistics summarized responses. Base of tongue resections were compared with lateral oropharyngectomies using \u03c7\u00b2 or Fisher\u2019s exact tests, with Cram\u00e9r\u2019s V for effect sizes; McNemar\u2019s test was used for paired binary data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Sixty-nine surgeons from 22 countries completed the survey (response rate 37.9%), most working in academic centers (73.9%). Prophylactic neck vessel ligation was routinely performed by about 60% of surgeons for both base of tongue and lateral oropharyngectomy, with no significant difference in overall use between subsites. Among surgeons performing ligation, lingual artery ligation was significantly more frequent in base of tongue procedures than in lateral oropharyngectomy (p &amp;lt; 0.001; Cram\u00e9r\u2019s V = 0.46). Routine tracheotomy was uncommon (4\u20139%) and mainly reserved for selected high-risk cases. Postoperative care varied substantially, with most patients hospitalized for \u22654 days and nasogastric tube use in 58\u201364% of cases. Local flap reconstruction was significantly more common after lateral oropharyngectomy than base of tongue resection, whereas free flap use did not differ between subsites.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our findings highlight considerable variability in perioperative and intraoperative management strategies for oropharyngeal TORS, reflecting the lack of standardized protocols. Differences in bleeding prevention and reconstructive techniques may be related to the anatomy of specific oropharyngeal subsites, underscoring the need for consensus-building efforts to harmonize TORS patient management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1864700","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T04:20:49Z","timestamp":1784521249000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Preventing bleeding and surgical complications in transoral robotic surgery for the oropharynx: results of a global survey"],"prefix":"10.3389","volume":"16","author":[{"given":"Elena","family":"Russo","sequence":"first","affiliation":[{"name":"Department of Sense Organs, \u2018Sapienza\u2019 University of Rome","place":["Rome, Italy"]},{"name":"Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital","place":["Taoyuan, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gian Marco","family":"Pace","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, Humanitas University","place":["Milan, Italy"]},{"name":"Otorhinolaryngology Unit, Istituto di ricovero e cura a carattere scientifico (IRCCS) Humanitas Research Hospital","place":["Milan, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Costantino","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, Humanitas University","place":["Milan, Italy"]},{"name":"Otorhinolaryngology Unit, Istituto di ricovero e cura a carattere scientifico (IRCCS) Humanitas Research Hospital","place":["Milan, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giannicola","family":"Iannella","sequence":"additional","affiliation":[{"name":"Department of Sense Organs, \u2018Sapienza\u2019 University of Rome","place":["Rome, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudio","family":"Sampieri","sequence":"additional","affiliation":[{"name":"Unit of Head and Neck Tumors, Hospital Cl\u00ednic","place":["Barcelona, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Armando","family":"De Virgilio","sequence":"additional","affiliation":[{"name":"Department of Sense Organs, \u2018Sapienza\u2019 University of Rome","place":["Rome, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,20]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1007\/s00405-014-2985-7","article-title":"Functional outcomes after TORS for oropharyngeal cancer: a systematic review","volume":"272","author":"Hutcheson","year":"2015","journal-title":"Eur Arch Otorhinolaryngol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1002\/hed.24101","article-title":"Analysis of post\u2013transoral robotic-assisted surgery hemorrhage: Frequency, outcomes, and prevention","volume":"38","author":"Mandal","year":"2016","journal-title":"Head Neck"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2018.10.020","article-title":"Evolution of robotic systems for transoral head and neck surgery","volume":"87","author":"Poon","year":"2018","journal-title":"Oral Oncol"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1002\/lary.20647","article-title":"Transoral robotic surgery for oropharyngeal squamous cell carcinoma: a prospective study of feasibility and functional outcomes","volume":"119","author":"Moore","year":"2009","journal-title":"Laryngoscope"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1007\/s00405-012-2097-1","article-title":"Oncologic and functional results after transoral laser microsurgery of tongue base carcinoma","volume":"270","author":"Canis","year":"2013","journal-title":"Eur Arch Otorhinolaryngol Off J Eur Fed Otorhinolaryngol Soc EUFOS Affil Ger Soc Otorhinolaryngol - Head Neck Surg"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2020.2996","article-title":"Robotic surgery and oncologic outcomes","volume":"6","author":"Hu","year":"2020","journal-title":"JAMA Oncol"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1002\/ohn.287","article-title":"Single-port versus multiport da Vinci system for transoral robotic surgery of hypopharyngeal and laryngeal carcinoma","author":"Sampieri","year":"","journal-title":"Otolaryngol Neck Surg"},{"key":"B8","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1002\/lary.28580","article-title":"Bleeding complications after transoral robotic surgery: a meta-analysis and systematic review","volume":"131","author":"Stokes","year":"2021","journal-title":"Laryngoscope"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2013.5097","article-title":"Analysis of postoperative bleeding and risk factors in transoral surgery of the oropharynx","volume":"139","author":"Pollei","year":"2013","journal-title":"JAMA Otolaryngol Neck Surg"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.oraloncology.2017.04.014","article-title":"The impact of prophylactic external carotid artery ligation on postoperative bleeding after transoral robotic surgery (TORS) for oropharyngeal squamous cell carcinoma","volume":"70","author":"Gleysteen","year":"2017","journal-title":"Oral Oncol"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1111\/coa.13041","article-title":"Haemorrhage following transoral robotic surgery","volume":"43","author":"Hay","year":"2018","journal-title":"Clin Otolaryngol"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1002\/hed.25362","article-title":"Analysis of readmissions after transoral robotic surgery for oropharyngeal squamous cell carcinoma","volume":"40","author":"Parhar","year":"2018","journal-title":"Head Neck"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1007\/s00405-021-07188-4","article-title":"Airway management during transoral robotic surgery for head and neck cancers: a French GETTEC group survey","volume":"279","author":"Poissonnet","year":"2022","journal-title":"Eur Arch Otorhinolaryngol"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1007\/s00405-026-10081-7","article-title":"Temporary tracheotomy in transoral robotic surgery (TORS): from a retrospective single-center analysis to a proposal of a decision-making algorithm","volume":"283","author":"Stringa","year":"2026","journal-title":"Eur Arch Otorhinolaryngol"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1111\/coa.13701","article-title":"Is tracheotomy necessary for transoral robotic surgery base of tongue reduction in obstructive sleep apnoea syndrome? Our experience in 20 patients","volume":"46","author":"Chekkoury Idrissi","year":"2021","journal-title":"Clin Otolaryngol"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjoto.2024.104436","article-title":"Features related to temporary tracheotomy in patients undergoing transoral robotic surgery (TORS) for supraglottic squamous cell cancer of the larynx: a systematic review","volume":"45","author":"Chiari","year":"2024","journal-title":"Am J Otolaryngol"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2017.02.022","article-title":"Complications following transoral robotic surgery (TORS): a detailed institutional review of complications","volume":"67","author":"Hay","year":"2017","journal-title":"Oral Oncol"},{"key":"B18","doi-asserted-by":"publisher","first-page":"287","DOI":"10.1007\/s11701-024-02042-1","article-title":"The swallowing and speech after transoral robotic surgery\u2014does the site impact the outcome","volume":"18","author":"Mettias","year":"2024","journal-title":"J Robot Surg"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1002\/lary.24748","article-title":"Feasibility of rapid discharge after transoral robotic surgery of the oropharynx","volume":"124","author":"Richmon","year":"2014","journal-title":"Laryngoscope"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1177\/0194599813495815a125","article-title":"Rapid discharge after transoral robotic surgery","volume":"149","author":"Richmon","year":"2013","journal-title":"Otolaryngol Neck Surg"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1055\/s-0032-1306376","article-title":"Reconstruction after robotic head and neck surgery: when and why","volume":"28","author":"Longfield","year":"2012","journal-title":"J Reconstr Microsurg"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1007\/s11701-023-01572-4","article-title":"Characteristics and outcomes of transoral robotic surgery with free-flap reconstruction for oropharyngeal cancer: a systematic review","volume":"17","author":"Monroe","year":"2023","journal-title":"J Robot Surg"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1864700\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T04:20:50Z","timestamp":1784521250000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1864700\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,20]]},"references-count":22,"alternative-id":["10.3389\/fonc.2026.1864700"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2026.1864700","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,20]]},"article-number":"1864700"}}