Interventional Sialendoscopy for Stones : Robotic Approaches

Transoral Robotic Surgery for Submandibular Sialolithiasis

Transoral robotic surgery (TORS) was invented at the University of Pennsylvania and subsequently Food and Drug Administration (FDA) approved in 2009. Transoral surgery of the submandibular gland for tumors and inflammatory disease has not been popular because access to the hilum is difficult. TORS has been utilized in the author's institution to allow better visualization for transoral submandibular gland excision, primarily for neoplasms. This remains a challenging operation. Sialendoscopy has been combined with transoral access to the posterior oral cavity to allow management of hilar stones.

Walvekar first reported using TORS for a submandibular megalith, and Razavi et al. have provided a series of patients using TORS in combined approaches for hilar stones.

TORS is now utilized for hilar stones in two different ways. The author has termed these approaches “TORS-sialo” and “Sialo-TORS-sialo”. In the former, TORS is done immediately and then followed by sialendoscopy for stones that are easily palpated, usually larger, most commonly single stones and is the more commonly performed operation. The Sialo-TORS-sialo approach is utilized for situations when evaluation of the duct and stone prior to doing the combined approach is needed.