Robotic Surgery for Salivary Gland Disease

Abstract

Robotic surgery has revolutionized surgical capabilities and continues to change surgical approaches and management. Robotic surgery is in its infancy with respect to head and neck surgery. However, there are several validated indications for robotics in ENT. The authors discuss the role of robotic surgery specifically related to salivary gland disease and discuss the indications, complications and anatomic nuances that justify the current role and continued effort to expand indications for robotic surgery in the field of head and neck surgery.

Contemporary Review of Submandibular Gland Sialolithiasis and Surgical Management Options

“…Transoral robotic surgery (TORS) utilizing the da Vinci surgical system has been utilized for various diseases of the head and neck, including resection of oncologic disease of the oropharynx, hypopharynx, larynx, and parapharyngeal spaces, as well as for salivary gland disorders, including removal of floor of mouth ranulas, tumors of the submandibular gland, and salivary gland stones [57,[67][68][69][70]. Robotic-assisted procedures applied specifically to submandibular stone management include the combined approach of TORS and sialendoscopy, as well as robotic sialadenectomy [57]. The use of TORS is an appealing alternative to open approaches for salivary gland diseases that may offer better surgical access, less scarring with improved cosmesis, diminished blood loss, shorter hospital stays, and lower morbidity overall [57,71].…”

“…Robotic-assisted sialolithotomy is often used in combination with sialendoscopy, utilizing the da Vinci robot system for the surgical portion of the procedure [57,70]. Transoral robotic sialolithotomy has the advantage of removing larger stones intact, since extracorporeal and laser lithotripsy may increase the risk of injury to surrounding soft tissues while also adding substantially to operative time if the fragments become embedded in the ducts [74][75][76].…”

“…Larger (≥8 mm) submandibular stones as well as those that are difficult to access with sialendoscopy alone, such as intraparenchymal and perihilar stones, can be removed using a combined approach pairing sialendoscopy and transoral stone removal (Figure 2 ) [ 57 , 58 ]. First described by Francis Marchal in 2007, this technique involves the use of the sialendoscope to localize the sialolith before performing transoral surgery for stone extraction [ 42 ].…”

“…Additionally, limited exposure to the floor of the mouth due to reduced mouth opening, large teeth, or obesity will also make stone removal challenging without sialendoscopy. This further complicates the identification and preservation of the lingual nerve and the placement of sutures in the salivary duct for repair after sialolithotomy [ 57 , 58 ].…”

“…Robotic-assisted procedures applied specifically to submandibular stone management include the combined approach of TORS and sialendoscopy, as well as robotic sialadenectomy [ 57 ]. The use of TORS is an appealing alternative to open approaches for salivary gland diseases that may offer better surgical access, less scarring with improved cosmesis, diminished blood loss, shorter hospital stays, and lower morbidity overall [ 57 , 71 ]. According to a study conducted by Tampino et al, in the combined TORS and sialendoscopy approach, there was a 94% success rate in their 33 patients, with 15.1% of patients experiencing transient tongue paresthesia [ 72 ].…”