Single Port Robot-Assisted Supraclavicular Flap Repair of Iatrogenic Hardware-Associated Pharyngeal Perforation: A Case Report.

Abstract

Background: The incidence of iatrogenic pharyngeal perforation has been reported to comprise 50%-75% of all pharyngeal perforations. In the context of anterior cervical diskectomy and fusion (ACDF) procedures, pharyngeal perforations are a known, although rare, complication with a morbidity and mortality rate of 4%.

Methods: In the following case report, we describe a 19-year-old male who underwent anterior and posterior spinal fusion following a traumatic fall. The patient's clinical course was complicated by persistent infection and hardware failure ultimately leading to a posterior hypopharyngeal perforation. The patient then underwent hyperbaric oxygen therapy followed by a subsequent operation to repair the posterior pharyngeal defect by placing a supraclavicular flap using the single-arm da Vinci robot. Due to the patient's quadriparesis and cervical spine hardware, his neck could not be extended for the operation, and meticulous care was taken to position him properly.

Results: Following the robot-assisted operative inset of the supraclavicular flap, the patient resumed hyperbaric oxygen therapy. Flexible nasopharyngoscopy on post-operative Day 3 showed adequate closure of the pharyngeal defect and an intact flap. A barium swallow study completed on post-operative Day 13 confirmed successful closure of the pharyngeal defect.

Conclusions: This case report affirms the utility of supraclavicular flaps in the repair of hardware-associated iatrogenic pharyngeal perforation and presents advantageous utilization of the single port da Vinci robot to assist in such operations with complicated exposure and limitations in patient positioning.