KATHRYN M. VAN ABEL: Hi. My name is Katie Van Abel. We're going to be talking today about prophylactic artery ligation after transoral robotic surgery for oropharynx tumors. This is something that we do to try and decrease the risk of catastrophic bleeding after these types of surgeries.

The risk with these procedures or with prophylactically ligating the vessels is that by interrupting the sympathetic fibers, you may theoretically increase the risk for post-operative first bite syndrome. This has been shown in some early studies and is certainly something that you should counsel your patients about. However, we feel that the benefit of decreasing catastrophic or life-threatening post-operative hemorrhage is worth taking.

So to get started, we isolate our carotid sheath structures. I like to start down at the carotid bulb because this will allow us to follow up the external carotid artery, looking for the first branch that takes off from this artery, which is our superior thyroid artery. When we're taking tumors that are down in the base of tongue, we would like to ligate the superior laryngeal artery to decrease bleeding.

Sometimes it's easy to see the superior laryngeal artery. However, sometimes it's not as obvious. And so in this scenario, I would ligate the superior thyroid artery. We do this by passing a mosquito around the vessel, using a single suture to ligate the vessel. And I do not actually divide them. We're just interrupting the blood flow.

The second vessel we routinely ligate for oropharynx tumors would be our lingual artery. The best landmark for finding this is the hypoglossal nerve. By following the external carotid artery up and looking under the hypoglossal nerve, you'll routinely find the lingual artery here. And we ligate it in the same manner.

The next artery we look for is our facial artery. This will be typically up and underneath the posterior belly of the digastric. Occasionally, you will have a common lingual facial trunk, but I would encourage everybody to make sure that they've fully investigated the length of the vessel to ensure that you're not missing a late takeoff of the facial artery.

Thank you so much for watching. Good luck with all of your procedures.