43 / 232
There were no intraoperative complications. The
overall TORS completion rate was 100%. No procedures
were converted to open or traditional endoscopic surgery.
Estimated blood loss ranged from 0 to 25 mL.
The majority of patients had high-grade American
Society of Anesthesiologists (ASA) classification: ASA I
(n
5
2), ASA 2 (n
5
1), ASA 3 (n
5
7), and ASA 4 (n
5
6) (Table I). The reason many patients in this series had
a high-grade ASA classification is related to their com-
plex medical conditions, but ASA grade was not a crite-
rion for eligibility. Three of 16 patients had a
tracheostomy tube in place prior to the operative case.
None of the patients required a new tracheostomy intra-
operatively or postoperatively. Five patients were kept
intubated after the procedure and were observed in the
pediatric intensive care unit (PICU) (1–4 days) for pro-
tection of the airway.
There were three postoperative complications. The
first patient was a 5-year old girl, ASA 3, who had a
type 1 laryngeal cleft and sleep-disordered breathing
(patient 8). On polysomnogram, the patient had an
apnea-hypopnea index of 0.3 (no obstructive apneas, 2
central apneas, and 2 hypopneas). The patient was not
treated surgically for the sleep-disordered breathing.
The patient underwent a TORS-assisted laryngeal cleft
repair and removal of supraglottic tissue using CO2
laser with FlexGuide ULTRA conduit (Omniguide, Lex-
ington, MA). The patient had no intraoperative compli-
cations, but required immediate reintubation in the
operating room at the end of the case due to copious
secretions. The patient was extubated successfully in the
PICU and discharged home on postoperative day 5.
The second patient was a 12-year-old girl who had
a history of caustic ingestion and resultant pharyngeal,
supraglottic, and esophageal strictures (patient 12). The
patient had an existent tracheostomy tube in place and
underwent multiple previous procedures addressing
strictures at the oral aperture, hypopharynx, and esoph-
agus. The patient underwent a TORS approach that
included pharyngectomy, supraglottic laryngectomy, and
base-of-tongue release. The surgical wound site was
allowed to heal by granulation. The patient had no
intraoperative complications but had poor tidal volumes
after surgery. Despite perioperative antibiotics, the
TABLE I.
Patient Characteristics.
Patient
Gender
Weight (kg)
ASA
Indication
1
F
23.7
4
Supraglottic lymphatic malformation
2
F
44
3
Hypopharyngeal and supraglottic lymphatic malformation
3
F
10
3
Type I laryngeal cleft
4
M
30
1
Pharyngeal and esophageal stricture
5
M
3.7
4E
Saccular cyst
6
M
13.1
4
Type II laryngeal cleft
7
F
10.8
3
Type I laryngeal cleft
8
F
29.4
3
Type I laryngeal cleft
9
M
2.5
4
Saccular cyst
10
F
27.6
1
Base of tongue hamartoma
11
F
52.5
3
Hypopharyngeal lymphatic malformation
12
F
34.2
4
Pharyngeal and esophageal stricture
13
M
8
3
Type III laryngeal cleft
14
M
7.03
3
Type II laryngeal cleft
15
F
93.7
2
Base of tongue lymphatic malformation
16
F
11.2
4
Type I laryngeal cleft
ASA
5
American Society of Anesthesiologists; F
5
female; M
5
male.
Fig. 3. Laryngeal cleft repair. (A) Palpation of the laryngeal cleft prior to repair; (B) close-up intraoperative view of the laryngeal cleft closure
during repair; (C) intraoperative view of the luminal side of laryngeal cleft after repair. [Color figure can be viewed in the online issue, which
is available at
www.laryngoscope.com.]
Zdanski et al.: TORS in Pediatric Population
21