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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.
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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.

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Figures

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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.

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Figure 2.
Robotic Equipment Positioning

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

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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.

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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.

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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.

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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.

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