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Robot-Assisted Sialolithotomy with Sialoendoscopy: A Novel Approach to Management of Large Submandibular Gland Stones

Objectives: (1) Describe robot-assisted sialolithotomy with sialoendoscopy (RASS) for the management of large submandibular gland (SMG) stones. (2) Analyze symptom recurrence and lingual nerve damage following RASS in comparison to the combined transoral sialoendoscopic approach (CTA). Methods: A retrospective case series was performed on patients with large palpable SMG stones managed with RASS. Large stones were defined as >4 mm, the upper limit that can be removed via sialoendoscopy. Fourteen patients who presented between October 2012 and January 2014 with mean stone size of 11.9 mm were identified. Patients were questioned regarding symptom recurrence, symptoms of lingual nerve damage, and procedural satisfaction at mean follow-up of 8 months. Procedural success was defined as absence of symptom recurrence in conjunction with gland preservation. These measures were compared to reported outcomes with CTA in the English literature. Results: Procedural success was 100% (14/14) for our series. No patients reported symptoms of lingual nerve damage at the time of follow-up, while 2 patients reported transient lingual nerve paresthesia (mean duration 2.5 weeks). Mean patient satisfaction was 9.8 on a scale of 10. Literature review identified 137 patients who underwent CTA for large SMG stones between 2005-2011. Procedural success rate for these patients was 75%. When commented on, lingual nerve damage was reported in 2% of patients. Conclusions: Preliminary data in management of large SMG stones with RASS shows improved procedural success in comparison to CTA. Furthermore, the morbidity of lingual nerve damage seen in CTA has yet to be encountered with RASS, likely due to improved visualization.