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Swartz AZ, Novoa Y Arruga Novoa V, Hassoun JS, Crispens MA, Prescott LS. Robotic-assisted gynecologic surgery associated tympanic membrane perforation: A report of two cases and review of the literature. Gynecol Oncol Rep 2023; 46:101151. [PMID: 36873858 PMCID: PMC9982598 DOI: 10.1016/j.gore.2023.101151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/10/2023] [Accepted: 02/14/2023] [Indexed: 02/25/2023] Open
Abstract
Robotic gynecologic surgery is associated with the use of steep Trendelenburg positioning. Steep Trendelenburg is necessary to provide optimal exposure to the pelvis but is associated with an increased risk of non-surgical complications such as suboptimal ventilation, facial and laryngeal edema, increased intraocular and intracranial pressure as well as neurologic injury. Several case reports have described otorrhagia after robotic assisted surgery; however, there are limited reports on the risk of tympanic membrane perforation. To our knowledge, there are no published reports on tympanic membrane perforation in gynecologic nor gynecologic oncology surgery. We report two cases of perioperative tympanic membrane rupture and bloody otorrhagia associated with robot-assisted gynecologic surgery. In both cases otolaryngology/Ear Nose and Throat (ENT) was consulted, and the perforations resolved with conservative management.
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Affiliation(s)
- Alison Z Swartz
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | | | - Jenine S Hassoun
- Vanderbilt University Medical Center, Department of Gynecologic Oncology, Nashville, TN, USA
| | - Marta A Crispens
- Vanderbilt University Medical Center, Department of Gynecologic Oncology, Nashville, TN, USA
| | - Lauren S Prescott
- Vanderbilt University Medical Center, Department of Gynecologic Oncology, Nashville, TN, USA
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Teh RA, Hoshal S, Hoshal GL, Ozturk A, Chang J, Assadsangabi R, Ivanovic V, Bobinski M, Raslan OA. Bilateral external auditory canal masses following repair of ruptured abdominal aortic aneurysm and open decompressive exploratory laparotomy for compartment syndrome: A rare case of spontaneous bilateral otorrhagia. Radiol Case Rep 2020; 15:2660-2662. [PMID: 33101561 PMCID: PMC7575648 DOI: 10.1016/j.radcr.2020.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 10/01/2020] [Accepted: 10/02/2020] [Indexed: 11/28/2022] Open
Abstract
Very few cases of spontaneous otorrhagia (SO) following nonotolaryngologic surgery have ever been reported in surgical literature and none in radiographic. Of the surgical cases reported, SO occurred in the perioperative period following laparoscopic surgeries in the Trendelenburg position. We report the first case of spontaneous bilateral otorrhagia which presented as bilateral external auditory canal masses following endovascular surgery and open decompressive laparotomy in a 60-year-old male with a prior history of hypertension and smoking. We seek to inform radiologists that SO can present on neck imaging as external auditory canal masses as a complication of nonotolaryngologic surgery away from the imaged field of view.
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Affiliation(s)
- Richard Andrew Teh
- Section of Neuroradiology, Department of Radiology, University of California-Davis Medical Center, 2315 Stockton Blvd, Sacramento, CA 95817
| | - Steven Hoshal
- Department of Otolaryngology, Head and Neck Surgery, University of California-Davis Medical Center, 2315 Stockton Blvd, Sacramento, CA 95817
| | - Gillian L Hoshal
- Department of General Surgery, University of California-Davis Medical Center, 2315 Stockton Blvd, Sacramento, CA 95817
| | - Arzu Ozturk
- Section of Neuroradiology, Department of Radiology, University of California-Davis Medical Center, 2315 Stockton Blvd, Sacramento, CA 95817
| | - Jennifer Chang
- Section of Neuroradiology, Department of Radiology, University of California-Davis Medical Center, 2315 Stockton Blvd, Sacramento, CA 95817
| | - Reza Assadsangabi
- Section of Neuroradiology, Department of Radiology, University of California-Davis Medical Center, 2315 Stockton Blvd, Sacramento, CA 95817
| | - Vladimir Ivanovic
- Section of Neuroradiology, Department of Radiology, University of California-Davis Medical Center, 2315 Stockton Blvd, Sacramento, CA 95817
| | - Matthew Bobinski
- Section of Neuroradiology, Department of Radiology, University of California-Davis Medical Center, 2315 Stockton Blvd, Sacramento, CA 95817
| | - Osama A Raslan
- Section of Neuroradiology, Department of Radiology, University of California-Davis Medical Center, 2315 Stockton Blvd, Sacramento, CA 95817
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Aloisi A, Pesce JE, Paraghamian SE, Chi DS, Rieth EF. Bilateral Otorrhagia after Robotically Assisted Gynecologic Surgery in the Setting of a Reduced Trendelenburg Position and Low-Pressure Pneumoperitoneum: A Case Report and Review of the Literature. J Minim Invasive Gynecol 2017; 24:1229-1233. [PMID: 28461176 DOI: 10.1016/j.jmig.2017.04.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 04/21/2017] [Accepted: 04/21/2017] [Indexed: 10/19/2022]
Abstract
Perioperative otorrhagia in association with nonotolaryngologic surgery is rare. The cause is typically attributed to the physiologic derangements associated with the Trendelenburg position and pneumoperitoneum during laparoscopic surgery. The most well-accepted etiology is an increase in arterial and venous pressures causing the rupture of subcutaneous capillaries, although the exact etiology remains unclear. We present the first reported case of bilateral spontaneous otorrhagia associated with robotically assisted laparoscopic surgery involving a reduced Trendelenburg position and low-pressure pneumoperitoneum. Perioperative hypertension, female gender, advanced age, and increased bleeding risk may contribute to the development of this rare complication.
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Affiliation(s)
- Alessia Aloisi
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Julianna E Pesce
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sarah E Paraghamian
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of California Irvine Medical Center, Orange, California
| | - Dennis S Chi
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, New York
| | - Elizabeth F Rieth
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
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