Evaluating the role of the self-assembling topical haemostat PuraBond® in Transoral Robotic Surgery (TORS) for oropharyngeal cancer: A case series.

Background: Transoral Robotic Surgery (TORS) has been increasingly employed in head and neck surgery for the assessment and treatment of malignancies over the last two decades. PuraBond® is a self-assembling viscous solution that forms a transparent hydrogel 3-D matrix to promote local haemostasis. This study aimed to assess the utility of PuraBond® in patients undergoing TORS for Human Papilloma Virus (HPV) positive oropharyngeal squamous cell carcinoma (OPSCC). Methods: All patients who underwent TORS with PuraBond® between October 2021-May 2022 at a single tertiary university hospital in the United Kingdom were included. Primary outcome measures included post-operative haemorrhage rate (primary; within 24hrs of surgery, secondary; 1-30 days post-surgery). Secondary outcome measures included, Length Of hospital Stay (LOS), swallowing complications, hospital re-admission, and surgeon-reported ease of PuraBond® application. Results: Twelve patients were included (13 procedures due to one second look and re-resection case). No patients developed primary or secondary post-operative haemorrhage. There were no re-attendances within 30 days. Average LOS was 2.78 days (range: 1.54-4.31 days). No patient required feeding tube insertion or tracheostomy. In all procedures, the use of PuraBond® was reported as 'easy'. Conclusion: This is the first study to evaluate the role of PuraBond® in TORS. The wide range of favourable outcomes reported support its safety and efficacy. The current findings mandate the need for larger, prospective, controlled studies to better define whether the known haemostatic and regenerative properties of PuraBond® may translate into direct patient benefit in the expanding field of TORS for HPV-mediated OPSCC.