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Abougamil A, L Srinivasan H, Fiandeiro CE, D C Kumar R, Bibby S, Booth TC, Hasegawa H, Walsh DC. Robotically facilitated parafasicular microsurgery to a brain arteriovenous malformation in a paediatric patient. Br J Neurosurg 2025; 39:289-295. [PMID: 37652406 DOI: 10.1080/02688697.2023.2239902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 05/26/2023] [Accepted: 07/18/2023] [Indexed: 09/02/2023]
Abstract
PURPOSE We report what we believe is the first application of robotically constrained image-guided surgery to approach a fistulous micro-arteriovenous malformation in a highly eloquent location. Drawing on institutional experience with a supervisory-control robotic system, a series of steps were devised to deliver a tubular retractor system to a deeply situated micro-arteriovenous malformation. The surgical footprint of this procedure was minimised along with the neurological morbidity. We hope that our contribution will be of assistance to others in integrating such systems given a similar clinical problem. CLINICAL PRESENTATION A right-handed 9-year old girl presented to her local emergency department after a sudden onset of severe headache accompanied by vomiting. An intracranial haemorrhage centred in the right centrum semiovale with intraventricular extension was evident and she was transferred urgently to the regional paediatric neurosurgical centre, where an external ventricular drain (EVD) was sited. A digital subtraction angiogram demonstrated a small right hemispheric arteriovenous shunt irrigated by peripheral branches of the middle cerebral artery & a robotically facilitated parafasicular microsurgical approach was performed to disconnect the arteriovenous malformation. CONCLUSION We describe the successful microsurgical in-situ disconnection of a deeply-situated, fistulous micro-AVM via a port system itself delivered directly to the target with a supervisory-control robotic system. This minimised the surgical disturbance along a relatively long white matter trajectory and demonstrates the feasibility of this approach for deeply located arteriovenous fistulae or fistulous AVMs.
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Affiliation(s)
- Ahmed Abougamil
- Department of Neurovascular Surgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Harishchandra L Srinivasan
- Department of Epilepsy and Functional Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Carlos E Fiandeiro
- Department of Neuroanaesthesia, King's College Hospital NHS Foundation Trust, London, UK
| | - Robin D C Kumar
- Department of Neuroanaesthesia, King's College Hospital NHS Foundation Trust, London, UK
| | - Steven Bibby
- Department of Interventional Neuroradiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Thomas C Booth
- Department of Interventional Neuroradiology, King's College Hospital NHS Foundation Trust, London, UK
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Harutomo Hasegawa
- Department of Epilepsy and Functional Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
- Department of Paediatric Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Daniel C Walsh
- Department of Neurovascular Surgery, King's College Hospital NHS Foundation Trust, London, UK
- Department of Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
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Whiteman E, Rehman U, Hussien M, Sarwar MS, Harsten R, Brennan PA. Implementation of robotic systems in paediatric craniofacial and head and neck surgery: a narrative review of the literature. Br J Oral Maxillofac Surg 2025; 63:165-173. [PMID: 39956664 DOI: 10.1016/j.bjoms.2024.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 10/24/2024] [Accepted: 11/29/2024] [Indexed: 02/18/2025]
Abstract
Surgical challenges in paediatric craniofacial and head and neck surgery can include operating in a small cavity, limited depth perception, restricted access with difficult angulations, and poor visualisation. Delicate tissue handling, muscle dissection, and suturing at depth require surgical access in congruence with the use of operative microscopes. Robotic assistance may aid surgeons in operating in confined spaces with minimal access incisions by improving the degree of freedom of operative instrumentation. In this study, we aim to review the use of robotic systems in paediatric head and neck and craniofacial surgery by focussing on total complications and length of surgery together with patient and surgeon experience. A literature search was conducted in June 2023 by two independent reviewers on Pubmed, Dynamed, DARE, EMBASE, Cochrane and British Medical Journal (BMJ) electronic databases for articles published between 1960-2024. Seventeen papers met the inclusion criteria. Seventy-nine patients were included. The success rate for head and neck and craniofacial cases that included robotic-assistance was 93.7% (n = 74) and the complication rate was 16.0% (n = 12). Robotic-assisted surgery demonstrates a low complication rate in treating a range of different pathologies in the head and neck in our included studies. Robotic-assistance in craniofacial surgery demonstrates promise in preventing iatrogenic injury from more traditional methods, and could allow for operations to proceed earlier in life in the management of midface distraction, however, more research in the area is necessary with limited research published at present.
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Affiliation(s)
- Elena Whiteman
- Foundation Doctor, Department of Surgery, Hillingdon Hospital, London, United Kingdom.
| | - Umar Rehman
- Core Surgical Trainee, Department of Plastic Surgery, Chelsea and Westminster Hospital, London, United Kingdom.
| | - Mehitab Hussien
- Plastic Surgery Registrar, Department of Plastic Surgery, Queen Elizabeth Birmingham Hospital, Birmingham, United Kingdom.
| | - Mohammad Sohaib Sarwar
- Locum Clinical Fellow, Department of Oral and Maxillofacial Surgery, The Queen Victoria Hospital, East Grinstead, United Kingdom.
| | - Rebecca Harsten
- Plastic Surgery Registrar, Department of Plastic Surgery, The Royal London Hospital, London, United Kingdom.
| | - Peter A Brennan
- Honorary Professor of Surgery, Consultant Oral and Maxillofacial Surgeon, Department of Oral and Maxillofacial Surgery, Queen Alexandra Hospital, Portsmouth, United Kingdom.
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Gottman DC, Corbisiero MF, Saeedi A, Bothwell S, Svoboda E, Ai A, Roy S. Assessing robotic-assisted procedures in pediatric otolaryngology: A systematic review and meta-analysis. Int J Pediatr Otorhinolaryngol 2024; 187:112175. [PMID: 39608153 DOI: 10.1016/j.ijporl.2024.112175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2024] [Revised: 11/07/2024] [Accepted: 11/21/2024] [Indexed: 11/30/2024]
Abstract
BACKGROUND Robotic-assisted surgery is increasingly used in pediatric otolaryngology, offering potential benefits like improved cosmetic outcomes. However, challenges such as longer operative times, higher costs, and a steep learning curve remain. OBJECTIVES This systematic review and meta-analysis assess whether robotic-assisted surgery offers advantages in operative time, complication rates, hospital stay, and cosmetic outcomes compared to traditional methods in pediatric patients. METHODS A literature search identified 20 studies, with six focused on thyroidectomy. Data on operative time, complications, hospital stay, and cosmetic outcomes were extracted and analyzed. RESULTS No significant differences in operative time or complications were found for robotic-assisted thyroidectomy, but it showed superior cosmetic outcomes and, in some cases, shorter hospital stays. Additional analyses suggested feasibility and functional benefits of other robotic procedures. CONCLUSIONS Robotic-assisted surgery in pediatric otolaryngology is as safe and efficient as traditional methods, with added cosmetic and functional benefits. Further large-scale trials are needed.
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Affiliation(s)
- Drew C Gottman
- University of Colorado School of Medicine, Aurora, CO, USA.
| | | | - Arman Saeedi
- University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Ellie Svoboda
- University of Colorado School of Medicine, Aurora, CO, USA
| | - Andy Ai
- University of Colorado, Colorado Springs, CO, USA
| | - Soham Roy
- Department of Otolaryngology - Head and Neck Surgery, University of Colorado, Aurora, CO, USA; Department of Otolaryngology - Head and Neck Surgery, Children's Hospital of Colorado, Aurora, CO, USA
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Huerta CT, Beres AL, Englum BR, Gonzalez K, Levene T, Wakeman D, Yousef Y, Gulack BC, Chang HL, Christison-Lagay ER, Ham PB, Mansfield SA, Kulaylat AN, Lucas DJ, Rentea RM, Pennell CP, Sulkowski JP, Russell KW, Ricca RL, Kelley-Quon LI, Tashiro J, Rialon KL. Management and Outcomes of Pediatric Lymphatic Malformations: A Systematic Review From the APSA Outcomes and Evidence-Based Practice Committee. J Pediatr Surg 2024; 59:161589. [PMID: 38914511 DOI: 10.1016/j.jpedsurg.2024.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 05/25/2024] [Accepted: 05/29/2024] [Indexed: 06/26/2024]
Abstract
BACKGROUND Significant variation in management strategies for lymphatic malformations (LMs) in children persists. The goal of this systematic review is to summarize outcomes for medical therapy, sclerotherapy, and surgery, and to provide evidence-based recommendations regarding the treatment. METHODS Three questions regarding LM management were generated according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Publicly available databases were queried to identify articles published from January 1, 1990, to December 31, 2021. A consensus statement of recommendations was generated in response to each question. RESULTS The initial search identified 9326 abstracts, each reviewed by two authors. A total of 600 abstracts met selection criteria for full manuscript review with 202 subsequently utilized for extraction of data. Medical therapy, such as sirolimus, can be used as an adjunct with percutaneous treatments or surgery, or for extensive LM. Sclerotherapy can achieve partial or complete response in over 90% of patients and is most effective for macrocystic lesions. Depending on the size, extent, and location of the malformation, surgery can be considered. CONCLUSION Evidence supporting best practices for the safety and effectiveness of management for LMs is currently of moderate quality. Many patients benefit from multi-modal treatment determined by the extent and type of LM. A multidisciplinary approach is recommended to determine the optimal individualized treatment for each patient. LEVEL OF EVIDENCE: 4
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Affiliation(s)
| | - Alana L Beres
- Division of Pediatric General and Thoracic Surgery, St. Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Brian R Englum
- Division of Pediatric Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Katherine Gonzalez
- Division of Pediatric Surgery, St. Luke's Children's Hospital, Boise, ID, USA
| | - Tamar Levene
- Division of Pediatric Surgery, Joe DiMaggio Children's Hospital, Hollywood, FL, USA
| | - Derek Wakeman
- Division of Pediatric Surgery, University of Rochester, Rochester, NY, USA
| | - Yasmine Yousef
- Division of Pediatric Surgery, Joe DiMaggio Children's Hospital, Hollywood, FL, USA
| | - Brian C Gulack
- Division of Pediatric Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Henry L Chang
- Department of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | | | - Phillip Benson Ham
- Division of Pediatric Surgery, John R. Oishei Children's Hospital, University at Buffalo, Buffalo, NY, USA
| | - Sara A Mansfield
- Division of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Afif N Kulaylat
- Division on Pediatric Surgery, Penn State Children's Hospital, Hershey, PA, USA
| | - Donald J Lucas
- Division of Pediatric Surgery, Naval Medical Center San Diego, CA, USA; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Rebecca M Rentea
- Division of Pediatric Surgery, Children's Mercy- Kansas City, Kansas City, MO, USA; Department of Surgery, University of Missouri- Kansas City, Kansas City, MO, USA
| | | | - Jason P Sulkowski
- Division of Pediatric Surgery, Children's Hospital of Richmond, Richmond, VA, USA
| | - Katie W Russell
- Division of Pediatric Surgery, University of Utah, Salt Lake City, UT, USA
| | - Robert L Ricca
- Division of Pediatric Surgery, University of South Carolina, Greenville, SC, USA
| | - Lorraine I Kelley-Quon
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Department of Surgery, University of Southern California, Los Angeles, CA, USA
| | - Jun Tashiro
- Division of Pediatric Surgery, Hassenfeld Children's Hospital, NYU Langone Health, New York, NY, USA
| | - Kristy L Rialon
- Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.
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Worden CP, Prince AC, Kirse SN, Rutter C, Shields BH, Hackman TG, Yarbrough WG, Zanation AM, Zdanski CJ. Transoral robotic surgery for pediatric upper airway pathology: An institutional update. Int J Pediatr Otorhinolaryngol 2024; 184:112073. [PMID: 39154570 PMCID: PMC11380919 DOI: 10.1016/j.ijporl.2024.112073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 08/11/2024] [Accepted: 08/14/2024] [Indexed: 08/20/2024]
Abstract
OBJECTIVE Provide an update on our institution's experience with utilizing transoral robotic surgery (TORS) in pediatric airway surgery and compare these results to surgery by traditional methods. METHODS Pediatric patients who underwent TORS for treatment of upper airway pathology between 2010 and 2021 at our institution were retrospectively identified and compared to patients with the same or similar pathology who underwent a traditional (open or endoscopic) surgical approach over the same time period. Outcomes of interest included patient demographics, operative times, adverse events, hospital length of stay (LOS), and modified barium swallow (MBSS) results. RESULTS Forty children (19M, 21F) underwent 46 TORS procedures. Mean age was 6.4 years (range: 6 days-17 years). Most commonly treated pathology included: laryngeal clefts (LC) (n = 18), lymphatic malformations (n = 9), and base of tongue masses (n = 7). Surgical time was decreased in traditional type I LC repairs (mean: 111 vs 149 min, P = 0.04) and lymphatic malformation excisions (59 vs 120 min, p = 0.005). Hospital LOS was increased in TORS type I LC repairs (2.6 vs 1.2 days, P = 0.04). Adverse event rate was similar between TORS and traditional cohorts (17 % vs 16 % cases, P = 0.9). Postoperative MBSS results were improved for TORS type I LC repairs at 6 months (70 % vs 33 %, P = 0.09) and 12 months (82 % vs 43 %, P = 0.05). CONCLUSIONS Pediatric TORS is practical and safe and has comparable outcomes to traditional surgery. Robotic-assisted LC repair displayed improved postoperative swallow results versus traditional approaches and may be particularly useful in recurrent cases. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Cameron P Worden
- Department of Otolaryngology - Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, 27599, USA.
| | - Andrew C Prince
- Department of Otolaryngology - Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, 27599, USA
| | - Samuel N Kirse
- Department of Otolaryngology - Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, 27599, USA
| | - Christopher Rutter
- Department of Otolaryngology - Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, 27599, USA
| | - Benjamin H Shields
- Department of Otolaryngology - Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, 27599, USA
| | - Trevor G Hackman
- Department of Otolaryngology - Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, 27599, USA
| | - Wendell G Yarbrough
- Department of Otolaryngology - Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, 27599, USA; Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, 27599, USA; Lineberger Comprehensive Cancer Center, University of North Carolina School of Medicine, Chapel Hill, NC, 27599, USA
| | - Adam M Zanation
- Carolina Ear, Nose & Throat - Sinus and Allergy Center, PA, USA
| | - Carlton J Zdanski
- Department of Otolaryngology - Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, 27599, USA
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Worden CP, Prince AC, Kirse SN, Rutter C, Hackman TG, Yarbrough WG, Zanation AM, Zdanski CJ. Pediatric Robotic Laryngeal Cleft Repair. Otolaryngol Head Neck Surg 2024; 171:254-260. [PMID: 38488232 PMCID: PMC11449495 DOI: 10.1002/ohn.723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 02/06/2024] [Accepted: 02/19/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVE Compare surgical and swallow outcomes in robotic versus traditional laryngeal cleft (LC) repairs. STUDY DESIGN Retrospective cohort study. SETTING Tertiary care pediatric hospital. METHODS Pediatric patients who underwent robotic or traditional (open or endoscopic) LC repair between 2010 and 2021 were identified. Patient characteristics, operative times, adverse events, hospital length of stay (LOS), and modified barium swallow study (MBSS) results were compared. RESULTS Eighteen robotic and thirty traditional LC repairs were identified. Mean surgical (149 vs 111 min, P < .05) and OR times (207 vs 139 min, P < .002) were increased for robotic type I LC repairs, but were similar for type II and III LC. Mean hospital LOS was increased for robotic type I LC repairs (2.6 vs 1.2 days, P < .006), but was decreased for type II (4 vs 12.2 days) and type III (4.3 vs 94.5 days) LC. Postoperative MBSS results were improved for robotic type I LC repairs at 12 months (82% vs 43%, P = .05), and trended toward improvement at 6 months for type II (75% vs 22%), and type III (67% vs 50%) LC repairs, although significance was limited for type II and III LC due to the number of subjects. A robotic approach was used successfully to revise all recurrent LC that failed traditional repairs. CONCLUSION Robotic type 1 LC repairs demonstrated increased operative times and hospital LOS but improved postoperative swallow outcomes compared to traditional approaches may be particularly useful in cases of recurrent clefts.
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Affiliation(s)
- Cameron P Worden
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Andrew C Prince
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Samuel N Kirse
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Christopher Rutter
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Trevor G Hackman
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Wendell G Yarbrough
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Adam M Zanation
- Carolina Ear, Nose & Throat-Sinus and Allergy Center, PA, Hickory, North Carolina, USA
| | - Carlton J Zdanski
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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Vinit N, Vatta F, Broch A, Hidalgo M, Kohaut J, Querciagrossa S, Couloigner V, Khen-Dunlop N, Botto N, Capito C, Sarnacki S, Blanc T. Adverse Events and Morbidity in a Multidisciplinary Pediatric Robotic Surgery Program. A prospective, Observational Study. Ann Surg 2023; 278:e932-e938. [PMID: 36692109 DOI: 10.1097/sla.0000000000005808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To report one-year morbidity of robotic-assisted laparoscopic surgery (RALS) in a dedicated, multidisciplinary, pediatric robotic surgery program. Summary Background Data. RALS in pediatric surgery is expanding, but data on morbidity in children is limited. METHODS All children who underwent RALS (Da Vinci Xi, Intuitive Surgical, USA) were prospectively included (October 2016 to May 2020; follow-up ≥1 year). Analyzed data: patient characteristics, surgical indication/procedure, intraoperative adverse events (ClassIntra classification), blood transfusion, hospital stay, postoperative complications (Clavien-Dindo). RESULTS Three hundred consecutive surgeries were included: urology/gynecology (n=105), digestive surgery (n=83), oncology (n=66), ENT surgery (n=28), thoracic surgery (n=18). Median age and weight at surgery were 9.5 [interquartile range (IQR)=8.8] years and 31 [IQR=29.3] kg, respectively. Over one year, 65 (22%) children presented with ≥1 complication, with Clavien-Dindo ≥III in 14/300 (5%) children at ≤30 days, 7/300 (2%) at 30-90 days, and 12/300 (4%) at >90 days. Perioperative transfusion was necessary in 15 (5%) children, mostly oncological (n=8). Eight (3%) robotic malfunctions were noted, one leading to conversion (laparotomy). Overall conversion rate was 4%. ASA ≥3, weight ≤15 kg, and surgical oncology did not significantly increase the conversion rate, complications, or intraoperative adverse events (ClassIntra ≥2). ASA score was significantly higher in children with complications (Clavien-Dindo ≥III) than without (p=0.01). Median hospital stay was 2 [IQR=3] days. Three children died after a median follow-up of 20 [IQR=16] months. CONCLUSIONS RALS is safe, even in the most vulnerable children with a wide scope of indications, age, and weight. Robot-specific complications or malfunctions are scarce.
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Affiliation(s)
- Nicolas Vinit
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
- Faculté de Médecine Paris Centre, Université Paris Cité, Paris, France
| | - Fabrizio Vatta
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Aline Broch
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Mary Hidalgo
- Department of Pediatric Anesthesia and Intensive Care, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Jules Kohaut
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Stefania Querciagrossa
- Department of Pediatric Anesthesia and Intensive Care, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Vincent Couloigner
- Faculté de Médecine Paris Centre, Université Paris Cité, Paris, France
- Department of Pediatric ENT, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Naziha Khen-Dunlop
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
- Faculté de Médecine Paris Centre, Université Paris Cité, Paris, France
| | - Nathalie Botto
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Carmen Capito
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Sabine Sarnacki
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
- Faculté de Médecine Paris Centre, Université Paris Cité, Paris, France
| | - Thomas Blanc
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
- Faculté de Médecine Paris Centre, Université Paris Cité, Paris, France
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8
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Goyal N, Goldenberg D, Ruszkay N, Tucker J, May J, Wilson MN. Can a flexible surgical robot be used in the pediatric population: A feasibility study. Int J Pediatr Otorhinolaryngol 2022; 159:111206. [PMID: 35759915 DOI: 10.1016/j.ijporl.2022.111206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/11/2022] [Accepted: 06/09/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Transoral robotic surgery in adults confers excellent results and decreased morbidity. Application of these techniques has not yet been rigorously investigated in children. The goal of this study is to evaluate the feasibility of a flexible robotic surgical system in a pediatric population. METHODS This was a non-randomized, non-blinded, prospective clinical trial. An Investigational Device Exemption was obtained from the FDA. Patients 8-12 years old scheduled for tonsillectomy and adenoidectomy between February and December 2019 at an academic tertiary care children's hospital were included. Exclusion criteria included pulmonary or vascular conditions posing risks for extended anesthesia, or a smaller mouth opening than the instrumentation (28 mm × 15 mm). Tonsillectomy was completed with standard monopolar cautery. After the surgery was complete, the robot was utilized for evaluation and assessment of exposure. A pediatric anesthesiologist screened patients for tolerance of additional anesthesia (up to 15 min). A flexible robotic surgical system, the MedRobotics Flex® Robotic System, was used to visualize and access the tonsillar fossa, posterior pharynx, base of tongue, epiglottis and false vocal folds. Visualization and access were graded on a five-point Likert scale. RESULTS A total of ten patients, eight males and two females, with obstructive sleep apnea (OSA) or sleep disordered breathing (SDB) were recruited in 2019. One patient did not complete the study due to equipment malfunction. The average patient demographics were: age 10.1 years (8.6-11.8 years), height 142.4 cm (127-164.9 cm), weight 47.5 kg (24.4-84.5 kg), and BMI 22.6 (13.9-31.0). Study time averaged 10.3 min (5-13 min). The tonsillar fossa, base of tongue, and posterior pharynx were visualized completely and easily accessed with the robotic instruments. The epiglottis and false vocal folds were visualized and accessed in 66% and 55% of patients, respectively. There were no adverse effects. CONCLUSIONS This study demonstrated that a flexible robotic surgical system is feasible for use in children 8-12 years of age when performing otolaryngology - head and neck surgery procedures of the oropharynx and larynx.
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Affiliation(s)
- Neerav Goyal
- Department of Otolaryngology, Penn State Milton S Hershey Medical Center, 500 University Drive, Hershey, PA, United States.
| | - David Goldenberg
- Department of Otolaryngology, Penn State Milton S Hershey Medical Center, 500 University Drive, Hershey, PA, United States
| | - Nicole Ruszkay
- Department of Otolaryngology, Penn State Milton S Hershey Medical Center, 500 University Drive, Hershey, PA, United States
| | - Jacqueline Tucker
- Department of Otolaryngology, Penn State Milton S Hershey Medical Center, 500 University Drive, Hershey, PA, United States
| | - Jason May
- Department of Otolaryngology, Penn State Milton S Hershey Medical Center, 500 University Drive, Hershey, PA, United States
| | - Meghan N Wilson
- Department of Otolaryngology, Penn State Milton S Hershey Medical Center, 500 University Drive, Hershey, PA, United States
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Lin HJ, Lin FCF, Yang TL, Chang CH, Kao CH, Tsai SCS. Cervical lymphatic malformations amenable to transhairline robotic surgical excision in children: A case series. Medicine (Baltimore) 2021; 100:e27200. [PMID: 34664849 PMCID: PMC8448076 DOI: 10.1097/md.0000000000027200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 08/25/2021] [Indexed: 11/25/2022] Open
Abstract
Lymphatic malformations are rare benign malformations that predominantly occur in the head and neck region. The advent of surgical robots in head and neck surgery may provide beneficial outcomes for pediatric patients. Here, we describe our experiences with transhairline incisions for robot-assisted surgical resection of cervical lymphatic malformations in pediatric patients.In this prospective longitudinal cohort study, we recruited consecutive patients under 18 years of age who were diagnosed with congenital cervical lymphatic malformations and scheduled for transhairline approach robotic surgery at a single medical center. We documented the docking times, console times, surgical results, complications, and postoperative follow-up outcomes.The studied patients included 2 with mixed-type lymphatic malformations and 2 with macrocystic-type lymphatic malformations. In all 4 patients, the incision was hidden in the hairline; the incision length was <5 cm in 3 patients but was extended to 6 cm in 1 patient. Elevating the skin flap and securely positioning it with Yang retractor took <1 hour in all cases. The mean docking time was 5.5 minutes, and the mean console time was 1 hour and 46 minutes. All 4 surgeries were completed endoscopically with the robot. The average total drainage volume in the postoperative period was 21.75 mL. No patients required tracheotomy or nasogastric feeding tubes. Neither were adverse surgery-associated neurovascular sequelae observed. All 4 patients were successfully treated for their lymphatic malformations, primarily with robotic surgical excisions.Cervical lymphatic malformations in pediatric patients could be accessed, properly visualized, and safely resected with transhairline-approach robotic surgery. Transhairline-approach robotic surgery is an innovative method for meeting clinical needs and addressing esthetic concerns.
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Affiliation(s)
- Han-Jie Lin
- Department of Otolaryngology, Tungs’ Taichung MetroHarbor Hospital, Taichung, Taiwan, Republic of China
| | - Frank Cheau-Feng Lin
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan, Republic of China
| | - Tsung-Lin Yang
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan, Republic of China
- College of Medicine, National Taiwan University, Taipei, Taiwan, Republic of China
| | - Chun-Hsiang Chang
- Department of Otolaryngology, Tungs’ Taichung MetroHarbor Hospital, Taichung, Taiwan, Republic of China
| | - Chia-Hui Kao
- Department of Pediatrics, Tungs’ Taichung MetroHarbor Hospital, Taichung, Taiwan, Republic of China
| | - Stella Chin-Shaw Tsai
- Department of Otolaryngology, Tungs’ Taichung MetroHarbor Hospital, Taichung, Taiwan, Republic of China
- Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan, Republic of China
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10
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Vianini M, Fiacchini G, Benettini G, Dallan I, Bruschini L. Experience in Transoral Robotic Surgery in Pediatric Subjects: A Systematic Literature Review. Front Surg 2021; 8:726739. [PMID: 34458318 PMCID: PMC8387868 DOI: 10.3389/fsurg.2021.726739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 07/19/2021] [Indexed: 02/03/2023] Open
Abstract
Pediatric transoral robotic surgery (TORS) has improved from 2007 to 2020, widening its indications and feasibility. This article aims to systematically analyze the procedures performed from the first use until the current year, observing their evolution over time. A systematic literature review was performed using PubMed, Scopus, Web of Science, and Cochrane databases between March 1, 2000, and April 1, 2020. We selected studies that were written only in English and were performed in live human subjects. About 16 studies were found with a total of 73 subjects treated, among them 41 were men and 32 were women with an average age of 6.8 ± 4.99 years. There have been four (5.47%) conversions. Both functional and benign-malignant diseases have been treated in the series. Eleven (15.06%) pre-operative tracheostomy and zero post-operative tracheostomy were performed. The bleeding data was only reported in 9 studies and was <50 ml. Only one (1.36%) intra-operative complication and 10 (12.32%) postoperative complications were reported. We consider the TORS procedures in pediatric subjects safe, feasible and with good surgical outcomes up to the laryngeal region.
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Affiliation(s)
- Matteo Vianini
- Otolaryngology, Audiology and Phoniatric Operative, Department of Surgical Pathology, Medical, Molecular and Critical Area, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Giacomo Fiacchini
- Otolaryngology, Audiology and Phoniatric Operative, Department of Surgical Pathology, Medical, Molecular and Critical Area, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Giacomo Benettini
- Otolaryngology, Audiology and Phoniatric Operative, Department of Surgical Pathology, Medical, Molecular and Critical Area, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Iacopo Dallan
- Otolaryngology, Audiology and Phoniatric Operative, Department of Surgical Pathology, Medical, Molecular and Critical Area, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Luca Bruschini
- Otolaryngology, Audiology and Phoniatric Operative, Department of Surgical Pathology, Medical, Molecular and Critical Area, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
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11
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Konuthula N, Parikh SR, Bly RA. Robotics in Pediatric Otolaryngology-Head and Neck Surgery and Advanced Surgical Planning. Otolaryngol Clin North Am 2020; 53:1005-1016. [PMID: 32917422 DOI: 10.1016/j.otc.2020.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Robotic surgery has been shown to be feasible and successful in several areas of pediatric head and neck surgery. However, adoption has been limited. Robotic surgery may be better integrated into practice with advanced preoperative surgical planning and the design of new robotic platforms with instrumentation specific for the application. With continued investigations, computer-aided surgical planning techniques including three-dimensional printing, virtual reality, multiobjective cost function for optimization of approach, mirror image overlay, and flexible robotic instruments may demonstrate value and utility over current practice.
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Affiliation(s)
- Neeraja Konuthula
- Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Washington, Seattle Children's Hospital, 1959 Northeast Pacific Street, Box 356515, Seattle, WA 98195, USA
| | - Sanjay R Parikh
- Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Washington, Seattle Children's Hospital, Seattle, WA, USA
| | - Randall A Bly
- Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Washington, Seattle Children's Hospital, 1959 Northeast Pacific Street, Box 356515, Seattle, WA 98195, USA.
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12
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13
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Venkatakarthikeyan C, Nair S, Gowrishankar M, Rao S. Robotic Surgery in Head and Neck in Pediatric Population: Our Experience. Indian J Otolaryngol Head Neck Surg 2020; 72:98-103. [PMID: 32158664 DOI: 10.1007/s12070-019-01768-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 11/19/2019] [Indexed: 10/25/2022] Open
Abstract
Robot assisted surgery of the head and neck is a relatively novel approach in the management of head and neck tumors. There are very few reported cases of robot-assisted surgery of the head and neck in pediatric population in the world literature and no report of such procedures in the Indian subcontinent. In this article we present three such cases we performed for the first time in the country. The first case is that of second branchial cleft cyst, the second is a 4-year-old boy with a tongue base cyst and the third patient is a 12-year-old girl with left parotid gland tumor. All the patients underwent successful Robotic surgeries. Case 1 underwent robotic excision of the cyst through a retroauricular hairline incision. Case 2 underwent transoral robotic excision of the tongue base cyst. Case 3 underwent robotic excision of the tumor through a modified facelift incision. The mean docking time for the robot was 12.33 min and approximate blood loss was less than 10 ml in all cases. The patient and their parents were extremely satisfied with the cosmetic outcomes of the scarless surgery. Robot assisted surgery has the advantage of performing minimally invasive procedures within constrained spaces especially in children. The multiarticulated endowrist movements of the robotic arms combined with higher magnification and three-dimensional depth perception allows a precise surgery with better visualization in otherwise inaccessible areas resulting in better surgical outcome. With exceptional advantages of scarless surgery, minimal blood loss and postoperative pain and better surgeon ergonomics, robotic technique is an effective and feasible option in Pediatric Head and neck Surgery.
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Affiliation(s)
- C Venkatakarthikeyan
- Department of Otorhinolaryngology and Head and Neck Surgery, Apollo Main Hospital, Room No. 25B Sindoori Block, Ground Floor, 21 Greams Lane, Off Greams Road, Chennai, 600006 India
| | - Swati Nair
- Department of Otorhinolaryngology and Head and Neck Surgery, Apollo Main Hospital, C-304 Pawitra Apartments, Vasundhara Enclave, Delhi, 110096 India
| | - M Gowrishankar
- Department of Otorhinolaryngology and Head and Neck Surgery, Apollo Main Hospital, Room No. 25B Sindoori Block, Ground Floor, 21 Greams Lane, Off Greams Road, Chennai, 600006 India
| | - Soorya Rao
- Department of Otorhinolaryngology and Head and Neck Surgery, Apollo Main Hospital, C-304 Pawitra Apartments, Vasundhara Enclave, Delhi, 110096 India.,Department of Otorhinolaryngology and Head and Neck Surgery, Apollo Main Hospital, S2, Gopalakrishna Flats, No. 14/21, Lake View Road, West Mambalam, Chennai, 600033 India
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14
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Alternative Applications of Trans-Oral Robotic Surgery (TORS): A Systematic Review. J Clin Med 2020; 9:jcm9010201. [PMID: 31940794 PMCID: PMC7019293 DOI: 10.3390/jcm9010201] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 01/01/2020] [Accepted: 01/08/2020] [Indexed: 02/07/2023] Open
Abstract
Background: The role of robotic surgery in the field of oncology has been widely described, in particular for the tumours of the oropharynx and larynx, but its efficacy for benign pathology is inconsistent. Methods: An exhaustive review of the English literature on trans-oral robotic surgery (TORS) for benign conditions was performed using PubMed electronic database. Results: The research was performed in March 2019 and yielded more than eight hundred articles, with 103 meeting the inclusion criteria and considered in the present study. Conclusions: The application of TORS for the treatment of obstructive sleep apnoea syndrome seems to be particularly well documented. Additionally, there exists a special interest in its use where high precision in limited anatomic space is required. There are still different structural and economic limitations for the application of TORS, however, the progressive technologic innovations and the increasing adoption of robotic surgery seem to encourage the uptake of this technique.
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15
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Al Omran Y, Abdall-Razak A, Ghassemi N, Alomran S, Yang D, Ghanem AM. Robotics in Cleft Surgery: Origins, Current Status and Future Directions. ROBOTIC SURGERY : RESEARCH AND REVIEWS 2019; 6:41-46. [PMID: 31921935 PMCID: PMC6935310 DOI: 10.2147/rsrr.s222675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 11/29/2019] [Indexed: 12/27/2022]
Abstract
The field of robotic surgery is an exciting and growing field that has bolstered its way to become a mainstream application in a number of surgical disciplines. The application of robotic surgery in cleft surgery is novel and has captivated many with the benefit it provides: the slender and small arms with wrist articulation at the instrument tip; motion scaling; tremor elimination; and high fidelity, three-dimensional visualization make the robot a very attractive platform for use in confined spaces with small surgical targets. The story of the origin of robotic surgery in cleft surgery is an interesting one, and one that has arisen from other allied surgical specialities to render robotic cleft surgery as its own specialised field. A field that has coined its own terms and has demonstrated a number of applications for its use. This review details the origins of robotic cleft surgery, its evolution and its current status and elaborates on future directions to enhance its application.
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Affiliation(s)
- Yasser Al Omran
- Department of Plastic Surgery, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | | | - Nader Ghassemi
- Department of Surgery, University Hospital North Midlands NHS Foundation Trust, Stoke-On-Trent, UK
| | - Samar Alomran
- Salmaniya Medical Complex, Manama, Kingdom of Bahrain
| | - Ding Yang
- University Hospital North Midlands NHS Foundation Trust, Stoke-On-Trent, UK
| | - Ali M Ghanem
- Academic Plastic Surgery Group, Barts and the London School of Medicine and Dentistry, London, UK
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16
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Preciado D. A current render of pediatric otolaryngology in the United States. Pediatr Investig 2019; 3:133-136. [PMID: 32851306 PMCID: PMC7331395 DOI: 10.1002/ped4.12139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 08/13/2019] [Indexed: 11/05/2022] Open
Affiliation(s)
- Diego Preciado
- Division of Pediatric Otolaryngology, Head and Neck SurgeryChildren's National Health SystemWashingtonDCUSA
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17
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DeHart AN, Korpon JR, Petersson RS. Transoral approach to type 1 laryngeal cleft repair: A novel, non-endoscopic technique. Int J Pediatr Otorhinolaryngol 2018; 114:97-100. [PMID: 30262376 DOI: 10.1016/j.ijporl.2018.07.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 07/05/2018] [Accepted: 07/17/2018] [Indexed: 10/28/2022]
Abstract
Endoscopic type 1 laryngeal cleft repair under spontaneous ventilation can be difficult in patients with poor pulmonary reserve. Intubation makes visualization of the interarytenoid area challenging during an endoscopic repair. As an alternative technique, we utilized a transoral, non-endoscopic approach with a McIvor mouth gag in two such patients. This provided adequate visualization and a larger working field with readily available instrumentation. The ability to intubate the patient obviated the need to intermittently place an endotracheal tube and allowed for uninterrupted working time. This technique does require favorable patient anatomy for adequate exposure, but is worth considering in certain patients.
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Affiliation(s)
- Austin N DeHart
- Department of Otolaryngology - Head and Neck Surgery, Virginia Commonwealth University, Richmond, VA, United States
| | - Jonathan R Korpon
- School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Rajanya S Petersson
- Department of Otolaryngology - Head and Neck Surgery, Virginia Commonwealth University, Richmond, VA, United States; Department of Otolaryngology - Head and Neck Surgery, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA, United States.
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18
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Robotic resection of lingual thyroglossal duct cyst in an infant. J Robot Surg 2018; 13:331-334. [PMID: 29980909 DOI: 10.1007/s11701-018-0841-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 07/04/2018] [Indexed: 10/28/2022]
Abstract
Thyroglossal duct cysts (TDCs) are the most common congenital midline neck masses. Lingual TDC is a rare variant that emerges as an isolated cyst at the tongue base. Unlike conventional procedures aiming removal of cyst, duct, and hyoid bone via open surgical access, a transoral cystectomy is mostly sufficient in cases with lingual TDC. We present a case describing a 3-month-old infant patient with lingual TDC who was successfully treated with transoral robotic surgery. The cyst wall was completely excised with no complications or obvious bleeding occurred. The operating time was 10 min. He had an uneventful postoperative course. Six months postoperatively, he is free of symptoms with no evidence of recurrence. Surgical treatment of lingual TDC in an infant is possible with transoral robotic approach and minimal risk of complication. Further studies are strongly needed to confirm the safety of robotic surgery in pediatric population.
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19
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Arnold MA, Mortelliti AJ, Marzouk MF. Transoral resection of extensive pediatric supraglottic neurofibroma. Laryngoscope 2018; 128:2525-2528. [DOI: 10.1002/lary.27186] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Revised: 02/13/2018] [Accepted: 02/21/2018] [Indexed: 01/31/2023]
Affiliation(s)
- Mark A. Arnold
- Upstate Medical University, Dept of Otolaryngology and Communication Sciences; Syracuse New York U.S.A
| | - Anthony J. Mortelliti
- Upstate Medical University, Dept of Otolaryngology and Communication Sciences; Syracuse New York U.S.A
| | - Mark F. Marzouk
- Upstate Medical University, Dept of Otolaryngology and Communication Sciences; Syracuse New York U.S.A
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20
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Management of Type I and Type II laryngeal clefts: controversies and evidence. Curr Opin Otolaryngol Head Neck Surg 2017; 25:506-513. [DOI: 10.1097/moo.0000000000000414] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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