Treatment of tongue base masses in children by transoral robotic surgery

Abstract

The feasibility and effectiveness of transoral robotic surgery (TORS) in children with tongue base masses (TBMs) were evaluated. Eight pediatric patients who were treated with TORS for TBMs between January 2010 and January 2016 at a tertiary hospital included in the study. All pathologies were congenital lesions: four were lingual thyroglossal ductus cysts (LTGDCs), one was a minor salivary gland tumor, one was a vallecular cyst, one was a bronchogenic cyst, and one was an ectopic thyroid tissue. TORS was performed successfully in all cases. The mean robotic set-up and exposure time was 13.0 ± 2.1 min (range 10-16 min) and the mean robotic surgery time was 8.8 ± 6.9 min (range 4-25 min). Estimated blood loss was lower than 5 ml for one patient and lower than 50 ml for another one. The remaining patients' estimated blood loss was lower than 10 ml. No patient required tracheostomy intra- or post-operatively. Only one minor complication occurred on day 10 after surgery (minor bleeding), which was resolved without intervention. No major complications or recurrence were observed. Better visualization and small, flexible arms allow surgeons to treat TBM faster and easily using TORS. This leads to decreased morbidity compared to open and transoral endoscopic/microscopic surgical methods. In the future, we believe that TORS may become the gold standard method for the treatment of pediatric TBM with continued development of robotic technology.

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

“…On intraoperative blood losses, only eight studies reported these data (5, 7, 8, 10-12, 15, 18), and in all cases, it was < 25 ml, except one subject < 50 ml (15).…”

“…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). Neoplastic pathology was treated in six subjects (8, 21%), four of these with malignant disease of the base-tongue: three sarcomas (4, 5, 14) and one minor salivary gland tumor (15).…”

“…The third most common intervention (7 subjects) was the exeresis of lingual thyroglossal duct cyst (6,11,15,17). Neoplastic pathology was treated in six subjects (8, 21%), four of these with malignant disease of the base-tongue: three sarcomas (4, 5, 14) and one minor salivary gland tumor (15). The remaining two subjects were affected by a benign pathology: one hamartoma (12) of the base tongue and the other neurofibroma of the larynx (16).…”

Asymptomatic vallecular cyst causing challenging intubation

“…[11] Son dönemde transoral robotik cerrahi yöntemini kullanarak pediatrik dil kökü kitlelerinde (lingual triglossal duktus kisti, valleküler kist, bronkojenik kist gibi) başarılı sonuçlar elde eden Kayhan ve ark. [12] ileride robotik cerrahinin pediatrik dil kökü kitlelerinde standart tedavi yöntemi olabileceğini vurgulamışlardır.…”

Robotic-Assisted Minimally Invasive Surgery in Children

“…Open surgery can facilitate access to the oropharyngeal region, including the base of the tongue, but can lead to the morbidity of splitting the lip and jaw or require pharyngotomy. As a result, the robotic transoral approach is being used [165]. In the near future, we believe that transoral robotic surgery may become the gold standard.…”