Rohan R. Walvekar

Management of giant sialoliths: Review of the literature and preliminary experience with interventional sialendoscopy

To report our experience with management of giant salivary stones via a combined approach technique using salivary endoscopy (CA) and results of a review of current literature related to giant salivary stones.

Robotic Transoral Periosteal Thyroidectomy (TOPOT): Experience in two cadavers

BACKGROUND Transoral techniques for endoscopic thyroidectomy have recently been reported, including a robotic transoral technique to access the thyroid gland. Herein, we developed a robotic transoral periosteal thyroidectomy technique. MATERIALS AND METHODS The da Vinci(®) Surgical System (Intuitive Surgical, Sunnyvale, CA) robot was used in two human cadavers to perform robotic transoral periosteal thyroidectomies. In the first cadaver, the anterior neck was exposed below the platysmal muscle. The anatomical spaces and surgical planes were observed with four ports by a periosteal approach. In the second cadaver, robotic transoral periosteal thyroidectomy was performed using three ports. RESULTS A total thyroidectomy and central neck dissection were performed in two cadavers using the da Vinci robot with the transoral periosteal approach. Complete thyroidectomy and central neck dissection were possible without injury to the recurrent laryngeal nerve. CONCLUSIONS Robotic transoral periosteal thyroidectomy provides superior access to the thyroid and central neck compartment. Transoral thyroidectomy using four ports is a feasible and safe method.

Robotic Thyroidectomy Versus Nonrobotic Approaches A Meta-Analysis Examining Surgical Outcomes

Background. Robotic surgery has been recently used as a novel tool for remote access thyroid surgery. We performed a meta-analysis of the current literature to examine the safety and oncological efficacy of robotic surgery compared to endoscopic and conventional approaches for different thyroid procedures. Methods. A systematic search of the online data bases was done using the following (MeSH) terms “robotic surgery,” “robotic thyroidectomy,” “robot-assisted thyroidectomy,” and “robot-assisted thyroid surgery.” Outcomes measured included total operative time, length of hospital stay, postoperative thyroglobulin levels, and postoperative complications. Statistical differences were analyzed between groups through the standard means and/or relative risk by using STATA analytical software. Results. In this study, 144 articles were identified; of which 18 of them met our inclusion criteria, totaling 4878 patients. Robotic approach was associated with longer total operative time (mean difference of 43.5 minutes) when compared to the conventional cervical approach (95% CI = 20.9-66.2; P < .001). Robotic approach was also found to have a similar risk of total postoperative complications when compared to the conventional and endoscopic approaches. Conclusion. Robotic thyroid surgery is as safe, feasible and provides similar periperative complications and oncological outcomes when compared to both, conventional cervical and endoscopic approaches. However, robotic thyroid surgery is associated with longer operative time when compared to the conventional open approach.

Pediatric peritonsillar abscess: Quinsy ie versus interval tonsillectomy.

PERITONSILLAR ABSCESS Quinsy versus interval tonsillectomy. OBJECTIVES STUDY DESIGN Case series with chart review. METHODS We reviewed the records of children treated for peritonsillar abscess between 2007 and 2011 at an academic tertiary pediatric hospital. We identified patients by searching the hospital database for all children treated for the ICD-9 code 475 (peritonsillar abscess). Data points extracted included length of stay, intraoperative blood loss, operative time, and incidence of complications. Statistical analysis was performed to identify significant differences between treatment categories. Children who never received a tonsillectomy (CPT codes 42820/42821/42825/42826) were excluded. RESULTS 34 children received tonsillectomy for peritonsillar abscess from 2007 to 2011. Of these: 23 received a Quinsy tonsillectomy, and 11 received antibiotics with or without incision and drainage, followed by tonsillectomy a minimum of 2 weeks later. Total hospital days in treatment course was 2.2 days for Quinsy tonsillectomy group and 2.3 days for the interval tonsillectomy group. Estimated blood loss was less than 20 ml for both groups. Operative time was 38 min for Quinsy tonsillectomy and 39 min for interval tonsillectomy. There were no post-tonsillectomy hemorrhages. One patient in the interval tonsillectomy group required readmission for dehydration. CONCLUSION There were no significant differences in total hospital days, blood loss, operative time, or post-operative complications between Quinsy tonsillectomy and interval tonsillectomy in the treatment of pediatric peritonsillar abscess.

Parotitis and Sialendoscopy of the Parotid Gland

Nonneoplastic disorders of the salivary glands involve inflammatory processes. These disorders have been managed conservatively with antibiotics, warm compresses, massage, sialogogues, and adequate hydration. Up to 40% of patients may have an inadequate response or persistent symptoms. When conservative techniques fail, the next step is operative intervention. Sialendoscopy offers a minimally invasive option for the diagnosis and management of chronic inflammatory disorders of the salivary glands and offers the option of gland and function preservation. In this article, we review some of the more common nonneoplastic disorders of the parotid gland, indications for diagnostic and interventional sialendoscopy, and operative techniques.

Remote access thyroid surgery

Robot assisted thyroid surgery has been the latest advance in the evolution of thyroid surgery after endoscopy assisted procedures. The advantage of a superior field vision and technical advancements of robotic technology have permitted novel remote access (trans-axillary and retro-auricular) surgical approaches. Interestingly, several remote access surgical ports using robot surgical system and endoscopic technique have been customized to avoid the social stigma of a visible scar. Current literature has displayed their various advantages in terms of post-operative outcomes; however, the associated financial burden and also additional training and expertise necessary hinder its widespread adoption into endocrine surgery practices. These approaches offer excellent cosmesis, with a shorter learning curve and reduce discomfort to surgeons operating ergonomically through a robotic console. This review aims to provide details of various remote access techniques that are being offered for thyroid resection. Though these have been reported to be safe and feasible approaches for thyroid surgery, further evaluation for their efficacy still remains.

The hospital otolaryngologist: The louisiana state university experience: The Hospital Otolaryngologist

To describe the implementation and impact of a hospital otolaryngologist in an academic medical center setting. Our hypothesis was that the hospital otolaryngologist would increase productivity of the Louisiana State University (LSU) faculty otolaryngologists and provide more timely access to inpatient otolaryngology services.

Robotic Surgery for Salivary Gland Disease

Robotic surgery has revolutionized surgical capabilities and continues to change surgical approaches and management. Robotic surgery is in its infancy with respect to head and neck surgery. However, there are several validated indications for robotics in ENT. The authors discuss the role of robotic surgery specifically related to salivary gland disease and discuss the indications, complications and anatomic nuances that justify the current role and continued effort to expand indications for robotic surgery in the field of head and neck surgery.