# Evaluating the Utility of Topical Haemostatic Adjuncts in Transoral Robotic Surgery (TORS)

## TL;DR

This study examines how topical haemostatic products affect outcomes in robotic surgery for throat cancer, finding they may help reduce bleeding and improve recovery.

## Contribution

The paper presents a novel combined approach of a retrospective cohort study and literature review on haemostatic adjuncts in TORS.

## Key findings

- One patient (5.6%) experienced secondary post-operative haemorrhage.
- Topical haemostatic adjuncts were used in 18 TORS procedures with varied product types.
- The study highlights the need for further research on the efficacy of specific haemostatic products.

## Abstract

Introduction: Transoral robotic surgery (TORS) is a minimally invasive modern surgical technique, offering novel access to the oral cavity with important implications for the management of oropharyngeal squamous cell carcinoma. However, TORS carries complications including haemorrhage, pain and impaired swallowing, with potentially significant implications for patients and healthcare systems.

Aim: This combined retrospective cohort study and literature review aims to explore our experience with the use of topical haemostatic products in TORS to improve post-operative outcomes.

Methods: We analysed our experience with the use of three different topical haemostatic adjuncts during TORS procedures at a major head and neck cancer centre from October 2023 to August 2024. The primary outcome measure was the rate of post-operative haemorrhage. This cohort study was complemented by a systematic review of the existing literature regarding the use of topical haemostatic products in TORS.

Results: Eighteen patients met criteria for inclusion. The type of topical haemostatic adjunct used varied between Tisseel (n=8, 44.4%), Floseal (n=4, 22.2%) and Purabond (n=6, 33.3%). One patient (5.6%) developed a secondary post-operative haemorrhage. Another patient (n=1, 5.6%) required admission for management of post-operative pain. Our experience provides preliminary insight into the utility of topical haemostatic adjuncts in TORS and underlines the need for further research in this area.

Conclusion: Topical haemostatic adjuncts, in our view, are useful, surgeon-friendly products that may augment haemostasis in TORS. Further studies are required to determine the efficacy of individual topical haemostatic products in preventing post-operative haemorrhage and enhancing recovery following TORS.