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Peer-reviewedCC BY-NC-NDJournal of robotic surgery

Postoperative hemorrhage and perioperative outcomes in single-port versus multi-port transoral robotic surgery for upper airway disease.

  • Wan-Ni Lin1,2
  • Wei-Hsuan Lee1,2
  • Li-Jen Hsin1,2
  • Ruei-Shan Hu1,2
  • Li-Pang Chuang2,3
  • Yi-An Lu1,2
  • Ming-Shao Tsai2,4
  • Hsueh-Yu Li1,2
  • Tuan-Jen Fang1,2
  • Li-Ang Lee5,6,7,8
8 affiliations
  1. 1Department of Otorhinolaryngology, Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
  2. 2School of Medicine, Chang Gung University, Taoyuan, Taiwan.
  3. 3Department of Pulmonary and Critical Care Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
  4. 4Department of Otorhinolaryngology, Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.
  5. 5Department of Otorhinolaryngology, Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan. [email protected].
  6. 6School of Medicine, Chang Gung University, Taoyuan, Taiwan. [email protected].
  7. 7School of Medicine, College of Life Science and Medicine, National Tsing Hua University, Hsinchu, Taiwan. [email protected].
  8. 8Department of Otorhinolaryngology-Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Gueishan District, Taoyuan City, 33305, Taiwan. [email protected].
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Abstract

The integration of transoral robotic surgery (TORS) has catalyzed a paradigm shift in the management of upper airway pathologies; however, the multifaceted operational distinctions between next-generation single-port (SP) platforms and conventional multi-port systems warrant comprehensive investigation. This retrospective analysis delves into the perioperative metrics and postoperative hemorrhage profiles of 126 patients undergoing TORS via the Si, Xi, and SP platforms. Procedures were categorized by complexity as single- or multilevel. To mitigate baseline confounders, we engineered a propensity-matched cohort of multilevel cases (n = 21 per platform). Overall, major postoperative hemorrhage manifested in 9.5% of the cohort. As anticipated, multilevel interventions underscored significant increases in operative duration, postoperative pain, and hospitalization length. In our unmatched analysis, the SP platform demonstrated a robust safety profile, yielding an overall hemorrhage rate of merely 3.1% (0% in single-level; 4.8% in multilevel), contrasting with higher incidences in the Si and Xi cohorts. Within the intricately matched multilevel subset, the SP system showcased significantly fewer major hemorrhage events compared to the Xi platform (4.8% vs. 28.6%). Crucially, this synergy cannot be solely attributed to robotic mechanics, as topical hemostatic agents were universally leveraged in matched SP cases. Exploratory hierarchical Firth penalized logistic regression illuminated that incorporating the robotic platform significantly augmented the predictive model (Firth p = 0.048), indicating the SP platform is associated with reduced hemorrhage odds (adjusted odds ratio = 0.22). Ultimately, this compelling evidence sheds light on the SP system's potential to optimize safety in complex airway reconstruction, necessitating future standardized prospective trials.

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Cite

BibTeXRIS
BibTeX
@article{lin2026postoperative,
  title = {{Postoperative hemorrhage and perioperative outcomes in single-port versus multi-port transoral robotic surgery for upper airway disease.}},
  author = {Wan-Ni Lin and Wei-Hsuan Lee and Li-Jen Hsin and Ruei-Shan Hu and Li-Pang Chuang and Yi-An Lu and Ming-Shao Tsai and Hsueh-Yu Li and Tuan-Jen Fang and Li-Ang Lee},
  journal = {Journal of robotic surgery},
  year = {2026},
  month = oct,
  doi = {10.1007/s11701-026-04083-0},
  url = {https://europepmc.org/article/MED/42911439},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Postoperative hemorrhage and perioperative outcomes in single-port versus multi-port transoral robotic surgery for upper airway disease.
AU  - Wan-Ni Lin
AU  - Wei-Hsuan Lee
AU  - Li-Jen Hsin
AU  - Ruei-Shan Hu
AU  - Li-Pang Chuang
AU  - Yi-An Lu
AU  - Ming-Shao Tsai
AU  - Hsueh-Yu Li
AU  - Tuan-Jen Fang
AU  - Li-Ang Lee
PY  - 2026
DA  - 2026/10/22
JO  - Journal of robotic surgery
DO  - 10.1007/s11701-026-04083-0
UR  - https://europepmc.org/article/MED/42911439
AB  - The integration of transoral robotic surgery (TORS) has catalyzed a paradigm shift in the management of upper airway pathologies; however, the multifaceted operational distinctions between next-generation single-port (SP) platforms and conventional multi-port systems warrant comprehensive investigation. This retrospective analysis delves into the perioperative metrics and postoperative hemorrhage profiles of 126 patients undergoing TORS via the Si, Xi, and SP platforms. Procedures were categorized by complexity as single- or multilevel. To mitigate baseline confounders, we engineered a propensity-matched cohort of multilevel cases (n = 21 per platform). Overall, major postoperative hemorrhage manifested in 9.5% of the cohort. As anticipated, multilevel interventions underscored significant increases in operative duration, postoperative pain, and hospitalization length. In our unmatched analysis, the SP platform demonstrated a robust safety profile, yielding an overall hemorrhage rate of merely 3.1% (0% in single-level; 4.8% in multilevel), contrasting with higher incidences in the Si and Xi cohorts. Within the intricately matched multilevel subset, the SP system showcased significantly fewer major hemorrhage events compared to the Xi platform (4.8% vs. 28.6%). Crucially, this synergy cannot be solely attributed to robotic mechanics, as topical hemostatic agents were universally leveraged in matched SP cases. Exploratory hierarchical Firth penalized logistic regression illuminated that incorporating the robotic platform significantly augmented the predictive model (Firth p = 0.048), indicating the SP platform is associated with reduced hemorrhage odds (adjusted odds ratio = 0.22). Ultimately, this compelling evidence sheds light on the SP system's potential to optimize safety in complex airway reconstruction, necessitating future standardized prospective trials.
SN  - 1863-2483
SN  - 1863-2491
ER  -