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

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.