0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Original Investigation |

Transoral Robotic-Assisted Lingual Tonsillectomy in the Pediatric Population

Rachel L. Leonardis, BS1; Umamaheswar Duvvuri, MD, PhD2; Deepak Mehta, MD3
[+] Author Affiliations
1University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
2Department of Otolaryngology, Veterans Affairs Pittsburgh Health System, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
3Department of Otolaryngology, Children’s Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
JAMA Otolaryngol Head Neck Surg. 2013;139(10):1032-1036. doi:10.1001/jamaoto.2013.4924.
Text Size: A A A
Published online

Importance  Since technologic advances allow the use of robotic assistance in various surgical interventions performed to treat pediatric otolaryngology patients, the feasibility and outcomes of potential procedures must be assessed.

Objective  To assess the feasibility and outcomes of robotic-assisted lingual tonsillectomy in the pediatric population.

Design, Setting, and Participants  Retrospective medical record review in a tertiary care children’s hospital of 16 pediatric patients who underwent robotic-assisted lingual tonsillectomy from March 1, 2011, through December 31, 2012.

Intervention  All patients underwent robotic-assisted lingual tonsillectomy using the da Vinci Surgical System (Intuitive Surgical, Inc) at the Children’s Hospital of Pittsburgh of the University of Pittsburgh Medical Center.

Main Outcomes and Measures  Demographic data, comorbidities, robot docking time, operative time, estimated blood loss, and postoperative course, including complications in the immediate and longer-term postoperative period, were collected and analyzed.

Results  All patients successfully underwent lingual tonsillectomy using the da Vinci Surgical System. Endotracheal intubation was performed in all patients and did not interfere with visualization of the oropharynx. Optimal retraction allowed visualization of pertinent structures and maximized transoral access. A significant learning curve from the first 5 surgical cases to subsequent cases with respect to robot docking time was observed (9 vs 3 minutes, respectively; P < .05). Operative time, estimated blood loss, and postoperative complication profiles are within the expected and acceptable limitations for performing lingual tonsillectomy in the pediatric population.

Conclusions and Relevance  Technologic advances have allowed miniaturization of robotic instrumentation and have expanded the scope of surgical options for the pediatric airway. Robotic-assisted lingual tonsillectomy is well tolerated and can be performed in the pediatric population with excellent success. It should be considered a feasible option for implementation at an institution-based level.

Figures in this Article

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Figures

Place holder to copy figure label and caption
Figure 1.
da Vinci Surgical System Positioning

The Dingman retractor is inserted into the mouth and secured to the Mayo stand to provide stability while performing transoral robotic-assisted lingual tonsillectomy. An assistant is positioned on the patient’s right side to provide suction. Of note, the patient shown has a tracheotomy tube, which is not visible.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
Robotic Equipment Positioning

Central position of the endoscope flanked by 2 robotic trocars is shown.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 3.
Mean Robot Docking Time as a Function of Case Number Performed

Mean ±1 SD is shown for cases 1 to 5, 6 to 10, and 11 to 16. Asterisk denotes statistically significant at P < .05.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 4.
Mean Estimated Blood Loss (EBL) as a Function of Case Number Performed

Mean ±1 SD is shown for cases 1 to 5, 6 to 10, and 11 to 16.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 5.
Mean Operative Time as a Function of Case Number Performed

Mean ±1 SD is shown for cases 1 to 5, 6 to 10, and 11 to 16.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 6.
Intraoperative Benefits of Robotic Lingual Tonsillectomy

The clean dissection plane, 3-dimensional endoscopic view, and magnification of key structures afforded by robotic assistance are exemplified here, with the glossopharyngeal nerve traversing the adjacent tissue at the glossotonsillar junction visualized during dissection.

Graphic Jump Location

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Topics
Jobs
JAMAevidence.com

Users' Guides to the Medical Literature
Clinical Resolution

Users' Guides to the Medical Literature
Clinical Scenario

brightcove.createExperiences();