Robotic Assisted Type 1 Laryngeal Cleft Repair

Contributors: Umamaheshwar Duvvuri (University of Pittsburgh Medical Center)

A DaVinci Robot is used to dock in with a 30 degree up telescope.The oral cavity is exposed using a FK retractor or a modified McIvor mouth gag( one with a flat blade). Robotic 5 mm Maryland forceps and 5 mm monopolar diathermy forceps is used. After getting a good exposure of the laryngeal cleft the diathermy at a setting of 4-5 watts is used to make the incision.and using the maryland forceps the laryngeal and esophageal flaps are created.A 5.0 PDS suture with a P2 tapered needle is used.The apex of the esophageal flap is first closed with suturing it.After this the apex of the laryngeal surface is closed.For a laryngeal cleft repair 2-4 sutures are required to obtain a closure. The sutures on the laryngeal surface are buried.The patient is kept intubated for a day or two to avoid excess movement of larynx. Pre and post operative treatment of reflux is important for healing.

DOI: http://dx.doi.org/10.17797/z17zngnuwp

Robotic-assisted Base of Tongue Resection for Adult Sleep Apnea

A 52-year-old female presented for an evaluation for sleep apnea surgery.  She complained of choking sensation at night.  She had an AHI of 6.7 events per hour, a oxygen saturation nadir of 71%, and BMI of 30.6.  She and a prior history of adenotonsillectomy as a child.  Flexible examination in the office revealed grade 4 lingual tonsil hypertrophy.  She was deemed a candidate for lingual tonsillectomy and was taken to the operating for robotic lingual tonsillectomy.  The technique for adult lingual tonsillectomy is shown in step-by-step fashion with tips for good results both operatively and functionally learned from robotic surgery for cancer of the unknown primary origin.

Contributors: Jessica Moskovitz, MD, Leila J. Mady, MD, PhD, MPH, Umamaheswar Duvvuri, MD, PhD

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