Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA.
Otolaryngol Head Neck Surg. 2021 Jul;165(1):76-82. doi: 10.1177/0194599820973231. Epub 2020 Dec 29.
To describe the management, technical nuances, and success rates of transoral robotic surgery (TORS)-assisted sialolithotomy.
Retrospective database review.
Quaternary academic medical center.
Between the months of January 2015 and May 2019, patients with hilar submandibular gland stones underwent 2 main variations of TORS-assisted sialolithotomy and sialendoscopy: (1) TORS followed by sialendoscopy for patients with palpable predominantly single stones and (2) either sialendoscopy followed by TORS and sialendoscopy or sialendoscopy followed by TORS only for patients with nonpalpable or multiple stones. Clinical charts were reviewed to collect data, including stone size (imaging review, intraoperative measurement), palpability, duration of operation, TORS variation, operative challenges, symptom improvement, gland preservation rate, and complications.
Thirty-seven patients were identified. Patients were 26 to 80 years old (mean, 57.2 years), and 40.5% were female. Twenty-four patients (64.9%) underwent TORS followed by sialendoscopy; 10 (27.0%), sialendoscopy followed by TORS and sialendoscopy; and 3 (8.1%), sialendoscopy followed by TORS only. The mean stone size was 12.4 mm (range, 4-28 mm). Eleven patients had multiple stones with a mean 4 stones per patient (range, 2-9). Procedural success was 91.9% (34/37) at a mean follow-up of 34.2 weeks (range, 1.4-262.1), and the gland preservation rate was 97.3% (36/37). No patients reported symptoms of lingual nerve injury at 3-month follow-up.
TORS combined with sialendoscopy for hilar submandibular gland sialolithiasis allows for improved visualization of critical anatomy, tissue manipulation, and operative flexibility. In our experience, the operative success rate is high, and duration of surgery compares favorably with conventional combined hilar approaches.
描述经口机器人手术（TORS）辅助涎石切开术的管理、技术细节和成功率。
回顾性数据库研究。
四级学术医疗中心。
在 2015 年 1 月至 2019 年 5 月期间，接受腮腺下颔部结石治疗的患者采用了 2 种主要的 TORS 辅助涎石切开术和涎腺内镜术：（1）对于可触及的主要单发结石患者，采用 TORS 辅助涎腺内镜术；（2）对于不可触及或多发结石患者，采用涎腺内镜术辅助 TORS 和涎腺内镜术或仅涎腺内镜术辅助 TORS。回顾临床图表以收集数据，包括结石大小（影像学检查、术中测量）、可触及性、手术时间、TORS 变化、手术挑战、症状改善、腺体保留率和并发症。
共确定了 37 例患者。患者年龄为 26 至 80 岁（平均年龄 57.2 岁），其中 40.5%为女性。24 例（64.9%）患者行 TORS 辅助涎腺内镜术；10 例（27.0%）患者行涎腺内镜术辅助 TORS 和涎腺内镜术；3 例（8.1%）患者行涎腺内镜术辅助 TORS 术。结石平均大小为 12.4mm（范围为 4-28mm）。11 例患者有多发性结石，平均每例患者有 4 个结石（范围为 2-9 个）。在平均随访 34.2 周（范围为 1.4-262.1 周）后，手术成功率为 91.9%（34/37），腺体保留率为 97.3%（36/37）。在 3 个月的随访中，没有患者报告出现舌神经损伤的症状。
TORS 联合涎腺内镜术治疗腮腺下颔部涎石病可改善对关键解剖结构的可视化，便于组织操作，手术灵活性更高。根据我们的经验，手术成功率高，手术时间与传统的联合入路相比具有优势。
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