Endo-robotic resection of the submandibular gland in a cadaver model.
BACKGROUND
By means of a prospective, nonrandomized investigation, we evaluated the feasibility of performing endo-robotic resection of the submandibular gland in a cadaver model and compared the results of robotically enhanced endoscopic surgery with those from a conventional endoscopic technique.


METHODS
Procedural times were recorded in a consecutive series of 11 endoscopic submandibular gland resections using the daVinci Surgical System (Intuitive Surgical, Sunnyvale, CA) and a modified endoscopic surgical approach previously developed in a porcine model. The presence of neurovascular injury was assessed postoperatively, and the specimens were examined histologically.


RESULTS
Eleven endo-robotic submandibular gland resections were successfully performed in six cadavers (no conversions to open resection were necessary). The median duration of the procedures was 48 minutes (range, 33-82 minutes). Creation of the operative pocket took an average (+/-SD) of 12.2 +/- 5.3 minutes, assembly of the robot required 9.3 +/- 4.1 minutes, and the mean time for submandibular gland resection was 29.4 +/- 8.9 minutes. The time required for robotic assembly was offset by the reduced operative time necessary compared with conventional endoscopic resection. Histologic examination confirmed the presence of normal glandular architecture, without evidence of excessive mechanical or thermal injury. There were no cases of apparent neurovascular injury.


CONCLUSIONS
Robotically enhanced endoscopic surgery in the neck is feasible and offers a number of compelling advantages over conventional endoscopic neck surgery. Clinical trials will be necessary to determine whether these advantages can be achieved in clinical practice.
Terris
David J
DJ
Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia, 1120 Fifteenth Street, Augusta, Georgia 30912-4060, USA. dterris@mcg.edu
Haus
Brian M
BM
Gourin
Christine G
CG
Lilagan
Paul E
PE
D002102:Cadaver; D004724:Endoscopy / Q000379:methods*; D005240:Feasibility Studies; D006801:Humans; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D011446:Prospective Studies; D012371:Robotics; D013363:Submandibular Gland / Q000601:surgery*