Otorrhagia during robotic colorectal resection: a two case series and review of the literature.

Perioperative otorrhagia is a rare complication of laparoscopic and robotic pelvic surgery performed in Trendelenburg position with pneumoperitoneum. We report two cases occurring during robotic colorectal resection performed in 25-degree Trendelenburg with 12 mmHg pneumoperitoneum. A 74 year old woman undergoing robotic sigmoid resection developed left sided otorrhagia intraoperatively, with computed tomography and otolaryngologic examination demonstrating blood in the external auditory canal and tympanic membrane injury. A 63 year old man undergoing robotic low anterior resection developed bilateral otorrhagia during emergence from anesthesia. Both patients were managed conservatively with otolaryngologic follow-up and recovered without ongoing bleeding or subjective hearing impairment. Previously reported cases have been described mainly in urologic and gynecologic surgery, usually under steeper Trendelenburg conditions. These cases show that perioperative otorrhagia may also occur during robotic colorectal surgery under moderate positioning parameters and is usually associated with a favorable outcome.