Salivary Endoscope and Robot Help Remove 20mm Salivary Stone

A salivary stone that measured 20 millimeters in diameter was removed from the salivary duct of a 31-year-old patient by a surgical robot guided through a salivary endoscope. Rohan R. Walvekar, MD, assistant professor in the Department of Otolaryngology, Head and Neck Surgery at Louisiana State University (LSU) in Baton Rouge headed up the procedure. Walvekar says it is the first time a salivary endoscope and surgical robot have been used in combination to remove such a large stone and repair the salivary duct from which it was taken.

Most salivary stones are smaller than 10 millimeters in diameter, and treating very large stones typically means complete removal of the patient’s salivary gland. The success of the procedure performed by Walvekar changes that prognosis. The ability to demonstrate a method that can save the gland and reduce the amounts of scarring and blood loss—and shorten a patient’s hospital stay—represents a significant advance in management of salivary stones within the submandibular gland.

Vital structures such as the lingual nerve, submandibular gland and salivary duct are also less likely to be compromised during dissections of the floor of the mouth because of the pinpoint accuracy of the tandem combination of the endoscope and robot. The endoscope provides clinicians an excellent surgical view, while the robot delivers a high definition, three-dimensional image and high level of dexterity for work to be performed inside of the oral cavity.

“We can offer minimally invasive, gland preserving, same day surgical procedures that represent a tremendous advance over the traditional gland removing surgery via neck incision that is recommended for this clinical condition,” notes Walvekar.

Salivary endoscopy has been used in Europe since the early 1990s, but is now gathering steam in the United States, according to Michael H. Fritsch, MD, FACS. Fritsch points out that while salivary endoscopy can be used to treat blocked salivary glands, it can also be utilized as a diagnostic tool for ductal pathology. He also suggest salivary endoscopy may become a replacement for most radiological examinations of the salivary ductal system.

“The immediate advantages,” Fritsch says, “are no incision, avoidance of open-surgical complications, immediate return to normal activities, and preservation of full oral function.”

Losing one major gland of the six salivary glands in the human body can cause a significant decrease in salivary function, he explains. Fritsch also says that difficult salivary problems may steer a clinician toward removing the complete gland when other solutions may not be readily apparent. For this reason he urges clinicians to embrace and use the advantages provided by this scientific advance.

Source: Louisiana State University; Otlaryngologic Clinics; December 2009