title: Robot-assisted sialolithotomy with sialendoscopy for the management of large submandibular gland stones.
abstract: OBJECTIVE
  The objectives of this study were to describe robot-assisted sialolithotomy with sialendoscopy (RASS) for the management of large palpable hilar submandibular gland (SMG) stones and analyze procedural success and lingual nerve damage following RASS in comparison to the combined transoral sialendoscopic approach.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  A retrospective chart review was performed on patients with large palpable hilar SMG stones managed with RASS following institutional review board approval. Large stones were defined as ≥5 mm, the upper limit that can be removed via sialendoscopy. Twenty-two patients between January 2012 and June 2014, with mean stone size of 12.3 mm, were identified. Data collected included symptoms of recurrence, postoperative lingual nerve function, and patient satisfaction at a mean follow-up of 14 months. Procedural success was defined as absence of symptom recurrence in conjunction with gland preservation. These measures were compared with the combined approach (CA) outcomes reported in the English literature.
  
  
  RESULTS
  Procedural success was 100% (22/22) for our cohort. No patients reported symptoms of lingual nerve damage at follow-up, whereas four patients reported transient lingual nerve paresthesia (mean duration, 2.5 weeks). Mean patient satisfaction was 9.9 out of 10. Literature review identified 135 patients in the CA cohort. Procedural success rate for these patients was 75%, and lingual nerve damage was reported in 2% of patients.
  
  
  CONCLUSIONS
  Our study demonstrates the safety and efficacy of RASS in the management of large SMG sialoliths. We attribute this preliminary success of RASS to the enhanced visualization, magnification, and technical advantages of the procedure.
  
  
  METHODS
  4.
authors.affiliation: Stony Brook University School of Medicine, Stony Brook, New York.
authors.forename: Christopher
authors.initials: C
authors.lastname: Razavi
authors.affiliation: Stony Brook University School of Medicine, Stony Brook, New York.
authors.forename: Celine
authors.initials: C
authors.lastname: Pascheles
authors.affiliation: Department of Surgery, Division of Otolaryngology, Stony Brook Medicine, Stony Brook University School of Medicine, Stony Brook, New York, U.S.A.
authors.forename: Ghassan
authors.initials: G
authors.lastname: Samara
authors.affiliation: Department of Otolaryngology and Communication Sciences, SUNY Upstate Medical University, Syracuse, New York.
authors.forename: Mark
authors.initials: M
authors.lastname: Marzouk
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D049690:History, Ancient; D006801:Humans; D008297:Male; D008875:Middle Aged; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D012371:Robotics; D015494:Salivary Gland Calculi / Q000175:diagnosis / Q000601:surgery*; D013363:Submandibular Gland / Q000601:surgery*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
keywords: Lingual nerve; Robotic surgery; Salivary glands; Sialendoscopy; Sialolith; Submandibular gland; head and neck