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Comparative Study
. 2024 Jul;171(1):254-260.
doi: 10.1002/ohn.723. Epub 2024 Mar 15.

Pediatric Robotic Laryngeal Cleft Repair

Cameron P Worden  1 , Andrew C Prince  1 , Samuel N Kirse  1 , Christopher Rutter  1 , Trevor G Hackman  1 , Wendell G Yarbrough  1   2   3 , Adam M Zanation  4 , Carlton J Zdanski  1
Affiliations
Comparative Study

Pediatric Robotic Laryngeal Cleft Repair

Cameron P Worden et al. Otolaryngol Head Neck Surg. 2024 Jul.

Abstract

Objective: Compare surgical and swallow outcomes in robotic versus traditional laryngeal cleft (LC) repairs.

Study design: Retrospective cohort study.

Setting: Tertiary care pediatric hospital.

Methods: Pediatric patients who underwent robotic or traditional (open or endoscopic) LC repair between 2010 and 2021 were identified. Patient characteristics, operative times, adverse events, hospital length of stay (LOS), and modified barium swallow study (MBSS) results were compared.

Results: Eighteen robotic and thirty traditional LC repairs were identified. Mean surgical (149 vs 111 min, P < .05) and OR times (207 vs 139 min, P < .002) were increased for robotic type I LC repairs, but were similar for type II and III LC. Mean hospital LOS was increased for robotic type I LC repairs (2.6 vs 1.2 days, P < .006), but was decreased for type II (4 vs 12.2 days) and type III (4.3 vs 94.5 days) LC. Postoperative MBSS results were improved for robotic type I LC repairs at 12 months (82% vs 43%, P = .05), and trended toward improvement at 6 months for type II (75% vs 22%), and type III (67% vs 50%) LC repairs, although significance was limited for type II and III LC due to the number of subjects. A robotic approach was used successfully to revise all recurrent LC that failed traditional repairs.

Conclusion: Robotic type 1 LC repairs demonstrated increased operative times and hospital LOS but improved postoperative swallow outcomes compared to traditional approaches may be particularly useful in cases of recurrent clefts.

Keywords: LC; MBSS; cleft; endoscopic; laryngeal; robotic; traditional.

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Conflict of interest statement

Research in this publication was supported by the NIDCD branch of the NIH under award number 5T32DC005360 (C.P.W). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. No authors have any financial conflicts of interest.

Figures

Figure 1.
Figure 1.. Comparison of surgical time between robotic and control laryngeal cleft (LC) repair cohorts.
Individual data points along with mean with 95% confidence interval included for robotic (n=18) and control (n=30) procedures. Type I LC (Robotic, n=11; Control, n=19), Type II LC (Robotic, n=4; Control, n=9), and Type III LC (Robotic, n=3; Control, n=2). * Two sample t-test P = 0.04 for difference in mean surgical time between robotic and control cohorts for type 1 LC repair.
Figure 2.
Figure 2.. Laryngeal cleft repair utilizing the da Vinci surgical robot.
(A) Denuding cleft mucosa with OmniGuide carbon dioxide (CO2) laser. (B) Approximating raw cleft edges with suture. C) Completed repair from esophageal side.
Figure 3.
Figure 3.. Comparison of postoperative MBSS improvement between robotic and control type 1 laryngeal cleft repair cohorts at A) 6 months, B) 12 months, and C) 24 months following surgery.
*Chi square P = 0.05 for difference in postoperative MBSS improvement rate between robotic and control cohorts at 12 and 24 months following surgery.
See this image and copyright information in PMC

References

    1. Rahbar R, Ferrari L, Borer J, Peters C. Robotic surgery in the pediatric airway: application and safety. Arch Otolaryngol Head Neck Surg 2007; 133:46–50. - PubMed
    1. Van Abel KM, Moore E The rise of transoral robotic surgery. Expert Rev Anticancer Ther 2012; 12: 373–380. - PubMed
    1. Leonardis R, Duvvuri U, Mehta D. Transoral robotic-assisted laryngeal cleft repair in the pediatric patient. Laryngoscope 2014; 124:2167–2169. - PubMed
    1. Zdanski CJ, Austin GK, Walsh JM, Drake AF, Rose AS, Hackman TG, Zanation AM. Transoral robotic surgery for upper airway pathology in the pediatric population. Laryngoscope. 2017. Jan;127(1):247–251. - PubMed
    1. Ferrell J, Roy S, Karni R, Yuksel S. Applications for transoral robotic surgery in the pediatric airway. Laryngoscope 2014; 124:2630–2635. - PubMed

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