Applications for transoral robotic surgery in the pediatric airway

Abstract

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Transoral robotic surgery for upper airway pathology in the pediatric population

“…It was first described in human pediatric patients by Rahbar et al with a case series of five patients in 2007 . Since that time, there have been seven case reports and case series presented in the literature; the largest describes 16 patients who underwent lingual tonsillectomy . The role of TORS in the pediatric airway is still evolving.…”

Experience in Transoral Robotic Surgery in Pediatric Subjects: A Systematic Literature Review

“…Five subjects underwent lingual tonsillectomy for non-OSAS diseases (7). The second most performed surgery was laryngeal cleft repair treating 18 subjects (1,8,9,12). The third most common intervention (7 subjects) was the exeresis of lingual thyroglossal duct cyst (6,11,15,17).…”

“…There was only one intra-operative complication (1.36%): a small buccal laceration that required a suture in a laryngeal cleft repair surgery (8). There were a total of nine postoperative complications (12.32%) worthy of note, including four pneumonia (7,12,19), one of which with septic shock (12), 4 bleedings (7, 10, 15) , and 1 edema of the tongue, which did not allow correct oral nutrition (9). There were four conversions (5.47%): three for oral exposure difficulties (1) and one subject was affected by posterior glottic stenosis.…”

“…Four conversions (5.47%) are identified: 3 for oral exposure difficulties, all in the first study of the series (1). The other case of conversion was because of the inability to have a good visual of the subglottis and difficulty with the placement of robotic arms in a subject with posterior glottic stenosis, following an inhalational burn injury (9). The learning curve provides the authors with a plausible reason behind the lack of other conversions in the series, other than the ones already described, despite more complex surgical interventions over the years.…”

Robotic Surgery in Pediatric Otolaryngology

“…Presently, TORS is FDA approved for head and neck tumor resection, and is commonly used for the treatment of early stage oropharyngeal and glottic tumors, which has been shown to reduce morbidity and improve functional outcomes. 5 Although the confined space in transoral surgery presents a challenge in all robotic head and neck surgery, this problem is escalated by pediatric anatomy. The challenge of introducing robotic arms into the oral cavity is considered by many to be the primary impediment to the implementation of surgical robotics in the pediatric airway.…”