Current Advances in Robotics for Head and Neck Surgery—A Systematic Review

Background. In the past few years, surgical robots have recently entered the medical field, particularly in urology, gynecology, and general surgery. However, the clinical effectiveness and safety of robot-assisted surgery (RAS) in the field of head and neck surgery has not been clearly established. In this review, we evaluate to what extent RAS can potentially be applied in head and neck surgery, in which fields it is already daily routine and what advantages can be seen in comparison to conventional surgery. Data sources. For this purpose, we conducted a systematic review of trials published between 2000 and 2021, as well as currently ongoing trials registered in clinicaltrials.gov. The results were structured according to anatomical regions, for the topics “Costs,” “current clinical trials,” and “robotic research” we added separate sections for the sake of clarity. Results. Our findings show a lack of large-scale systematic randomized trials on the use of robots in head and neck surgery. Most studies include small case series or lack a control arm which enables a comparison with established standard procedures. Conclusion. The question of financial reimbursement is still not answered and the systems on the market still require some specific improvements for the use in head and neck surgery.

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Noise in Otolaryngology – Head and Neck Surgery operating rooms: a systematic review

Journal of Otolaryngology - Head and Neck Surgery ◽

10.1186/s40463-020-00487-6 ◽

2021 ◽

Vol 50 (1) ◽

Author(s):

Gianluca Sampieri ◽

Amirpouyan Namavarian ◽

Marc Levin ◽

Justine Philteos ◽

Jong Wook Lee ◽

...

Keyword(s):

Systematic Review ◽

Head And Neck ◽

Patient Outcomes ◽

Noise Level ◽

Neck Surgery ◽

Operating Rooms ◽

Head And Neck Surgery ◽

Noise Levels ◽

Surgical Performance ◽

The Mean

Abstract Objective Noise in operating rooms (OR) can have negative effects on both patients and surgical care workers. Noise can also impact surgical performance, team communication, and patient outcomes. Such implications of noise have been studied in orthopedics, neurosurgery, and urology. High noise levels have also been demonstrated in Otolaryngology-Head and Neck Surgery (OHNS) procedures. Despite this, no previous study has amalgamated the data on noise across all OHNS ORs to determine how much noise is present during OHNS surgeries. This study aims to review all the literature on noise associated with OHNS ORs and procedures. Methods Ovid Medline, EMBASE Classic, Pubmed, SCOPUS and Cochrane databases were searched following PRISMA guidelines. Data was collected on noise measurement location and surgery type. Descriptive results and statistical analysis were completed using Stata. Results This search identified 2914 articles. Final inclusion consisted of 22 studies. The majority of articles analyzed noise level exposures during mastoid surgery (18/22, 82%). The maximum noise level across all OHNS ORs and OHNS cadaver studies were 95.5 a-weighted decibels (dBA) and 106.6 c-weighted decibels (dBC), respectively (P = 0.2068). The mean noise level across all studies was significantly higher in OHNS cadaver labs (96.9 dBA) compared to OHNS ORs (70.1 dBA) (P = 0.0038). When analyzed together, the mean noise levels were 84.9 dBA. Conclusions This systematic review demonstrates that noise exposure in OHNS surgery exceeds safety thresholds. Further research is needed to understand how noise may affect team communication, surgical performance and patient outcomes in OHNS ORs. Graphical abstract

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Late Free Flap Failure in Head and Neck Reconstruction: A Systematic Review

Ear Nose & Throat Journal ◽

10.1177/014556131809700712 ◽

2018 ◽

Vol 97 (7) ◽

pp. 213-216 ◽

Cited By ~ 2

Author(s):

David Forner ◽

Blair A. Williams ◽

Fawaz M. Makki ◽

Jonathan R.B. Trites ◽

S. Mark Taylor ◽

...

Keyword(s):

Systematic Review ◽

Head And Neck ◽

Free Flap ◽

Neck Surgery ◽

Head And Neck Surgery ◽

Head And Neck Reconstruction ◽

Time To Failure ◽

Close Monitoring ◽

Flap Failure ◽

Vascular Compromise

Our objectives were to review all reported cases of late flap failure in head and neck surgery and describe any relevant patterns. We conducted a systematic review of all published cases of free flap failure after postoperative day 7 in head and neck surgery from January 1990 to January 2018. Data were collected with respect to flap type, site of reconstruction, reason for failure, and time to failure. A total of 45 cases of late free flap failure in the head and neck were identified. Among the 34 cases in which the necessary data were available for analysis, 50% of late failures occurred between postoperative day 7 and 14. Common reasons for failure were abscess and vascular compromise. We conclude that most late flap failures occur in the second postoperative week. In patients with risk factors for flap failure, close monitoring for up to 14 days after surgery could detect flap compromise before the flap is lost.

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Does Surgical Volume and Complexity Affect Cost and Mortality in Otolaryngology–Head and Neck Surgery?

Otolaryngology ◽

10.1177/0194599819861524 ◽

2019 ◽

Vol 161 (4) ◽

pp. 629-634 ◽

Cited By ~ 2

Author(s):

Andrew J. Redmann ◽

Sonia N. Yuen ◽

Douglas VonAllmen ◽

Adam Rothstein ◽

Alice Tang ◽

...

Keyword(s):

Head And Neck ◽

Case Series ◽

Neck Surgery ◽

Mortality Rates ◽

Head And Neck Surgery ◽

Additional Case ◽

Complication Rates ◽

Total Cost ◽

Case Complexity ◽

Point Increase

Objectives (1) To evaluate whether admission volume and case complexity are associated with mortality rates and (2) evaluate whether admission volume and case complexity are associated with cost per admission. Study Design Retrospective case series. Setting Tertiary academic hospital. Subjects and Methods The Vizient database was queried for inpatient admissions between July 2015 and March 2017 to an otolaryngology–head and neck surgery service. Data collected included admission volume, length of stay, intensive care unit (ICU) status, complication rates, case mix index (CMI), and cost data. Regression analysis was performed to evaluate the relationship between cost, CMI, admission volume, and mortality rate. Results In total, 338 hospitals provided data for analysis. Mean hospital admission volume was 182 (range, 1-1284), and mean CMI was 1.69 (range, 0.66-6.0). A 1-point increase in hospital average CMI was associated with a 40% increase in odds for high mortality. Admission volume was associated with lower mortality, with 1% lower odds for each additional case. A 1-point increase in CMI produces a $4624 higher total cost per case (95% confidence interval, $4550-$4700), and for each additional case, total cost per case increased by $6. Conclusion For otolaryngology inpatient services at US academic medical centers, increasing admission volume is associated with decreased mortality rates, even after controlling for CMI and complication rates. Increasing CMI levels have an anticipated correlation with higher total costs per case, but admission volume is unexpectedly associated with a significant increase in average cost per case.

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Robotic surgery in oral and maxillofacial, craniofacial and head and neck surgery: A systematic review of the literature

International Journal of Oral and Maxillofacial Surgery ◽

10.1016/j.ijom.2012.05.035 ◽

2012 ◽

Vol 41 (11) ◽

pp. 1311-1324 ◽

Cited By ~ 20

Author(s):

J. De Ceulaer ◽

C. De Clercq ◽

G.R.J. Swennen

Keyword(s):

Systematic Review ◽

Robotic Surgery ◽

Head And Neck ◽

Neck Surgery ◽

Head And Neck Surgery ◽

Review Of The Literature

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Honey as a Treatment in Otorhinolaryngology: A Review by Subspecialty

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489418815188 ◽

2018 ◽

Vol 128 (3) ◽

pp. 193-207 ◽

Cited By ~ 2

Author(s):

Theresa Tharakan ◽

John Bent ◽

Raluca Tavaluc

Keyword(s):

Head And Neck ◽

Reconstructive Surgery ◽

Case Series ◽

Neck Surgery ◽

Head And Neck Surgery ◽

Cochrane Central Register ◽

Randomized Control Trials ◽

Randomized Control ◽

Level 1 ◽

Meta Analyses

Objectives: To provide an up-to-date review of honey’s effectiveness and potential applications in otorhinolaryngology. Methods: A literature search of the online databases PubMed, EMBASE, and Cochrane Central Register of Controlled Trials was conducted. Results: Sixty-three studies were identified within head and neck surgery (n = 23, 36%); pediatric otolaryngology (n = 18, 29%); rhinology, sinus, and skull base surgery (n = 11, 17%); otology (n = 6, 10%), facial plastic and reconstructive surgery (n = 3, 5%); and laryngology (n = 2, 3%). Studies included 6 meta-analyses, 44 randomized control trials, 5 case reports, and 8 animal models or in vitro studies. Of 55 clinical studies, 50 reported Level 1 evidence (prospective randomized control trials), and 5 reported Level 4 evidence (case series). The evidence level by subspecialty was: head and neck surgery (Level 1 n = 23), pediatrics (Level 1 n = 18), rhinology (Level 1 n = 7, level 4 n = 1), otology (Level 1 n = 1, Level 4 n = 3), facial plastics and reconstructive surgery (Level 4 n = 1), and laryngology (Level 1 n = 2). Conclusions: Honey can be used for a variety of otolaryngology conditions. The highest quality meta-analyses support oral honey for prevention and treatment of oral mucositis in cancer patients, cough associated with upper respiratory infection in children, and pain control after tonsillectomy. Further research will likely justify broader applications.

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Opioid Prescribing Patterns After Head and Neck Surgery

Otolaryngology ◽

10.1177/0194599821992365 ◽

2021 ◽

pp. 019459982199236

Author(s):

Punam A. Patel ◽

Lavanya Nagappan ◽

Daohai Yu ◽

Xiaoning Liu ◽

Cecelia E. Schmalbach

Keyword(s):

Head And Neck ◽

Pain Control ◽

Case Series ◽

Neck Surgery ◽

Head And Neck Surgery ◽

Prescribing Patterns ◽

Control Female ◽

Female Sex ◽

Phone Calls ◽

Younger Age

Objective Postoperative prescription narcotics increase access to opioids and associated abuse among patients, family, and acquaintances. Judicious opioid stewardship is required. Best practice questions remain for larger head and neck surgeries. We aim to review opioid utilization patterns in an urban patient population to identify patients at risk for poor postoperative pain control. Study Design Case series with planned chart review for patients undergoing head and neck surgery (2015-2018). Setting Single urban hospital. Methods Outcome measures included postoperative phone calls and emergency room visits as markers for inadequate pain control. Age, sex, race, body mass index (BMI), smoking status, comorbidities, prior narcotic filling behavior, surgery type, and duration were evaluated as potential risk factors for pain control. Chi-square and Wilcoxon tests were used for group comparisons. Results In total, 215 patients met inclusion criteria: male (22%), white/Hispanic (47%), and African American (44%). Median BMI was 31.6 kg/m2; median age was 52 years. Surgeries included total thyroidectomy (41%), hemithyroidectomy (27%), and parathyroidectomy (15%). The 23-hour observation patients (n = 175, 81%) had a median of 20 morphine milligram equivalents (MMEs). Sixteen patients experienced inadequate pain control. Female sex ( P = .03), younger age ( P = .02), current smoker ( P = .03), and higher inpatient MME ( P = .006) were associated with inadequate pain control. Conclusion Female sex, younger age, smokers, and high inpatient opioid dose requirements are associated with inadequately controlled pain. These patients may benefit from additional education, earlier postoperative visits, and a more comprehensive nonopioid regimen.

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