Meghan T. Turner

Introduction: Since its initial inception, robotic‐assisted minimally invasive surgery (RAMIS) is continually being applied to a wider array of procedures. However, there are significant limitations in current surgical subsystems, including a large learning curve, lack of effective haptic feedback, decreased surgical intuition, and decreased dexterity. Methods: A narrative review of the literature was conducted to provide an overview of key developments in the field. Relevant articles were identified through searches of PubMed, IEEE, Google Scholar, and EMBASE, along with manual screening of references. Results: A selection of representative articles covering topics including teleoperation, kinematics, dynamics, and haptic feedback is discussed to highlight major themes and recent advances. Conclusions: Despite recent advances, limitations to operator experience remain. Numerous strategies and approaches are currently being proposed and explored to further advance surgical subsystems, improving dexterity, haptic feedback, movement time delay, and learning curve.

Objectives: To investigate whether routine involvement of the medical hospitalist service (MHS) in postoperative medical management of head and neck cancer (HNC) patients undergoing major ablative head and neck surgery with free tissue transfer (FTT) improves inpatient outcomes. Methods: This is a retrospective cohort study. Patients undergoing FTT after head and neck oncologic surgery between 2014 and 2022 were identified. Starting September 2018, MHS were involved in the medical care of every FTT patient (post‐intervention). Prior to that, MHS were consulted on an as‐needed basis (pre‐intervention). Outcomes studied included transfer to a higher level of care (LOC), length of hospital stay (LOHS), 30‐day readmission, and 90‐day mortality. Data were analyzed using linear regression and generalized linear models. Results: A total of 362 patients were included in this study (mean age 62.3 ± 10.5 and 30.1% females), 32.9% of the cohort being in the pre‐intervention group. When comparing the post‐intervention to pre‐intervention groups, the risk difference (RD) for: (1) transfer to higher LOC was −7.4% (95% CI = −13.7 to −1.02, p = 0.02); (2) 30‐day readmission was −4.4% (95% CI = −14.0 to 5.3%, p = 0.36); and (3) 90‐day mortality was 2.4% (95% CI = −4.1 to 8.8, p = 0.49). Post‐intervention, the LOHS decreased by 1.2 days compared to pre‐intervention (95% CI = −3.9 to 1.5, p = 0.39). Conclusion: Involvement of MHS in the care of patients undergoing FTT halved the relative risk of transfer to higher LOC. There was no significant effect on mortality, readmission, or hospital stay. Further studies are needed to confirm our findings. Level of Evidence: 3.

Objectives: This systematic review with meta‐analysis is aimed to examine clinical presentations, pathologic and imaging findings, treatment approaches, and prognosis of inflammatory myofibroblastic tumour. Methods: PubMed, Medline, Scopus, Cochrane Central Register of Control Trials, Web of Science, Google Scholar, and Embase were systematically searched up to February 2026. The search strategy was structured by a combination of relevant keywords and medical subheadings. This review adhered to Preferred Reporting Items for Systematic reviews and Meta‐Analyses (PRISMA) guidelines and Population, Intervention, Comparison, and Outcome (PICO) statement. Results: A total of 22 studies, including 337 patients, met the inclusion criteria. Most of the tumours originated from the sinonasal space (40.1%, proportion = 163), and the maxilla bone and hypopharynx had the least frequency (0.3%, proportion = 1). The most prevalent manifestations were proptosis and facial pain/swelling. Regarding immunohistochemical findings, tumours were mostly positive for vimentin and SMA, while they were commonly negative for desmin, S‐100, anaplastic lymphoma kinase, and CD34. Many patients were treated with surgical resection alone without any recurrence occurring. Recurrence occurred in 21.6% (proportion = 67). Metastases occurred in 8.8% (proportion = 8). Conclusions: The diagnosis of head and neck inflammatory myofibroblastic tumour appears related to the presence of vimentin, SMA, desmin, anaplastic lymphoma kinase, CD34, and S‐100 on immunohistochemistry. The enhancement pattern on computed tomography cannot help diagnosis, but absence of calcification may distinguish tumour from other differential diagnoses. Surgical resection with a free margin is the most common treatment approach. Metastasis and malignant transformation rarely occur in this tumour of the head and neck region.

Background: The risk of postoperative hemorrhage (POH) with use of nonsteroidal anti‐inflammatory drugs (NSAIDs) after trans‐oral robotic surgery (TORS) oropharyngectomy is poorly described in the existing literature. Methods: A retrospective propensity‐matched cohort study was performed using the TriNetX database, with cohort assignments based on perioperative NSAID administration within 7 days of surgery. Results: 1761 patients undergoing TORS oropharyngectomy were identified, and divided into two equal propensity‐matched cohorts of 621. 660 patients (37.5%) received postoperative NSAIDs. The overall hemorrhage rate was 5.5%. There was no significant difference in primary POH (< 1.5% in the NSAID group and 1.2% in the group without NSAIDs), secondary POH (5.2% vs. 4.2%, OR = 1.243, 95% CI = 0.732, 2.112), emergency room (ER) presentation within 30 days (11.0% vs. 10.6%, OR = 1.034, 95% CI = 0.722, 1.480), or 30‐day mortality (< 1.5% and < 0.9%). Conclusions: In this study, NSAID use after TORS was not associated with an increased risk of primary or secondary POH, 30‐day return to ER, or 30‐day mortality rates. Only 37.5% of patients in this study received postoperative NSAIDS. NSAIDs may be underutilized in the treatment of post‐TORS pain.

Objective: To investigate practice patterns in the treatment of p16‐negative/human papillomavirus (HPV)‐negative oropharyngeal squamous cell carcinoma (OPSCC) among members of the American Head and Neck Society (AHNS). Study Design: Cross‐sectional. Setting: Online electronic survey. Methods: An online survey was distributed via AHNS survey system. Participation was voluntary, and data were anonymously collected. Results: 108 members (7.7% of AHNS members) responded. Most (65.7%) had ≥5 years of experience in the field. Few practitioners (23.2% always and 10.2% frequently) confirmed HPV‐negative status with DNA/RNA in situ hybridization or PCR testing for p16‐negative tumors. Most surgeons (60.2%) reported recommending TORS for identification of an unknown primary in a patient with p16‐/HPV‐negative neck mass. Similarly, at least half (56.5%) of surgeons indicated always or frequently treating resectable T1‐T3 with TORS. The majority (73.2%) of surgeons indicated infrequently (59.3%) or never (13.9%) treating T3/T4 with traditional open surgery as first line. More than half of the surgeons (57.4%) believed survival is better with surgery compared to definitive nonsurgical therapy for HPV‐negative OPSCC. There was wide variation in the use of treatment intensification (dual modality adjuvant treatment for T1‐2N0, or tri‐modality treatment for T1‐T2N1), with 19.4% reporting never, 36.1% infrequently, 34.3% frequently, and 10.2% always doing so. Conclusions: A majority of AHNS surgeons (57.4%) believe survival for HPV‐negative OPSCC is better with surgery. Most (56.5%) would treat resectable T1‐T3 tumors with TORS, while the minority (26.8%) would frequently or always operate on T3‐T4 tumors. There was wide variation in practice with respect to treatment intensifiication owing to remaining knowledge gaps in the field.

Transoral robotic surgery (TORS) for laryngeal cancer was first described in 2007. Since then, relatively small case series have supported the safety and feasibility in humans. We aimed to examine 90-day functional outcomes and complication rates after TORS for laryngeal cancer using a publicly available national database. The TriNetX database was queried for all laryngeal cancer patients ages 18–90 undergoing robotic surgery. Primary outcomes were five-year overall survival and 90-day rates of planned tracheostomy, postoperative gastrostomy, and overall complications. One-to-one propensity score matching was used to examine of the effect of tracheostomy and concurrent neck dissection on primary outcomes. 413 patients from 41 healthcare organizations were identified: 126 (30.6%) patients underwent neck dissection, 39 (9.4%) underwent tracheostomy, 94 (23.6%) required gastrostomy, and 43 (11.47%) incurred postoperative complications. Five-year overall survival for laryngeal cancer TORS patients was 72.41%. Before matching, neck dissection was associated with greater odds of overall complications (OR = 2.10, 95%CI = 1.08–4.07, p < 0.027) and gastrostomy (OR = 1.66, 95%CI = 1.06–2.59, p = 0.027). Tracheostomy was associated with greater odds of gastrostomy (OR = 6.80, 95%CI = 3.35–13.81, p < 0.001). Matching identified 115 with and without neck dissection and 34 patients with and without tracheostomy. After matching, neck dissection was no longer significantly associated with higher overall complication and gastrostomy rates. Post-matching effects of tracheostomy on outcomes could not be studied due to reduced overall numbers. TORS for laryngeal cancer has acceptable complication rates. Neck dissection was not associated with greater odds of complications or gastrostomy. Larger studies are needed to determine the effect of tracheostomy on complication and gastrostomy rates.

Background: Cystic lateral neck masses in adults commonly represent nodal metastases from HPV‐associated oropharyngeal squamous cell carcinoma (OPSCC) or benign lesions. Because cystic lesions are relatively acellular, fine‐needle aspiration (FNA) is often non‐diagnostic. HPV circulating tumor DNA (ct‐DNA) may aid diagnosis in these cases. Methods: We conducted a two‐institution retrospective review of patients with cystic neck masses and non‐diagnostic FNA who underwent pre‐treatment HPV ct‐DNA testing. Sensitivity, specificity, and predictive values were calculated based on final pathology. Results: Thirty‐two patients were included. HPV ct‐DNA was positive in 20/32 (62.5%) cases, all of which were HPV‐associated OPSCC. Four patients with negative HPV ct‐DNA were ultimately diagnosed with HPV‐associated OPSCC (sensitivity: 83%, specificity: 100%, PPV: 100%, NPV: 67%). Conclusion: HPV ct‐DNA demonstrated high specificity and may complement standard workup in adult cystic neck masses with non‐diagnostic FNA. Positive HPV ct‐DNA results should prompt further evaluation for HPV‐associated OPSCC.

Objective: To assess the performance of machine learning (ML) models trained on large publicly available databases in predicting extranodal extension (ENE) within a smaller single‐institution cohort. Methods: Patient data were derived from two datasets. The first, the NCDB containing 5551 patients, was used to train and validate the ML algorithms. NCDB data was split into training (80%) and testing (20%) sets. To ensure fair comparison of prediction performance, data were randomly divided. The second, the WVU cohort containing 62 patients, was used as an independent test set for validation and simulation of a real‐world scenario. Six key ENE‐related variables (predictors) were selected based on importance and data availability. Results: The generalizability of the ML models was validated using real data from our institute with an average AUC ROC of 0.74. Of all the models, AdaBoost had reasonable performance: precision of 72%, NPV of 0.74%, specificity of 0.81, AUC ROC of 0.74. Similarly, the XGBOOST and ensemble models demonstrated the strongest combination of sensitivity and precision, critical for correctly predicting ENE, with AUC ROC ranging from 0.71 to 0.75. Most models demonstrated modest sensitivity in predicting ENE. Conclusion: This study proved the feasibility of using ML algorithms to predict ENE by using oncologic variables from the NCDB as a training dataset. These trained models generalize well, such that they accurately predicted ENE on a real‐world single institution dataset. Level of Evidence: 3.

Circulating tumor DNA (ctDNA) has been developed as a marker of tumor burden in human papillomavirus (HPV)‐positive oropharyngeal squamous cell carcinoma (OPSCC). Inflammatory indices are also increasingly being used as prognostic surrogate markers in solid tumors, including head and neck cancers. The relationship between ctDNA levels and inflammatory indices has not been studied in HPV‐associated OPSCC. We hypothesize that higher levels of inflammation are associated with higher ctDNA levels. Herein, we demonstrate an association between high pretreatment ctDNA levels and specific inflammatory indices, which may be lower‐cost surrogate markers of high HPV ctDNA levels and may act as a surrogate marker for the body's immune response to HPV‐positive OPSCC.