The Utilization of Transoral Robotic Surgery in the Pediatric Patient



Fig. 15.1
Oral cavity access in pediatric patient for lingual tonsillectomy and base of tongue reduction





15.3 Procedures Performed





  1. 1.


    TORS of the lingual tonsil and base of tongue


    1. (a)


      Surgical procedure


      1. (i)


        McIvor or Dingman retractor is placed using a flat tongue blade.

         

      2. (ii)


        5 mm spatula cautery and Maryland forceps are utilized.

         

      3. (iii)


        30 degree 12 mm video endoscope provides a superior view of region.

         

      4. (iv)


        Care is taken to place the distal aspect of the tongue blade at the circumvallate papillae in order to expose the base of tongue and lingual tonsillar tissue.

         

      5. (v)


        The lingual tonsillar tissue is taken in two specimen sections starting from midline and moving laterally.


        1. 1.


          This improves visualization and enables the two specimens to be taken en bloc.

           

         

      6. (vi)


        The muscular aspect of the base of tongue is removed in similar medial to lateral fashion.


        1. 1.


          Care is taken not to extend deep into the base of tongue laterally in order to avoid the lingual artery.

           

         

      7. (vii)


        Area is irrigated and allowed to heal by secondary intention.

         

       

    2. (b)


      Complications


      1. (i)


        Intraoperative:


        1. 1.


          Hemorrhage

           

        2. 2.


          Dental trauma

           

        3. 3.


          Accidental extubation/loss of airway

           

         

      2. (ii)


        Postoperative


        1. 1.


          Pain

           

        2. 2.


          Dehydration

           

        3. 3.


          Bleeding


          1. (a)


            Minor bleed

             

          2. (b)


            Lingual artery hemorrhage

             

           

        4. 4.


          Infection

           

         

       

     

  2. 2.


    TORS for the treatment of laryngeal cleft


    1. (a)


      Surgical procedure


      1. (i)


        Patient is intubated for TORS-directed laryngeal cleft repair.

         

      2. (ii)


        Patient is suspended and the larynx is secured transorally using the F-K retractor.

         

      3. (iii)


        5 mm spatula cautery and Maryland forceps are utilized.

         

      4. (iv)

Tags:
Sep 21, 2017 | Posted by in OTOLARYNGOLOGY | Comments Off on The Utilization of Transoral Robotic Surgery in the Pediatric Patient

Full access? Get Clinical Tree
Get Clinical Tree app for offline access