Transoral robotic surgery in children

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Last week we performed the first pediatric transoral robotic surgery. A very special young patient with severe sleep apnea underwent conventional adenotonsillectomy but symptoms did persist. Due to patient´s characteristics CPAP was not an option. On drug induced sleep endoscopy a severe colapse produced by enlarged lingual tonsils was observed. Therefore lingual tonsillectomy was proposed.

There is very few experience with pediatric TORS. As far as we know the only published series for OSAS is from the Children´s Hospital of Pittsburg1. There are some other few case reports on pediatric Head&Neck robotic surgery2,3,4,5.

Performing TORS on a patient under 25 kg was a challenge. Particularly with the 8mm endowrist of the da Vinci Xi. Also we were unable to get the right blade for the mouthgag. But the procedure was uneventful. We discharged the patient the next day on normal oral diet. Immediate clinical improvement was observed. Waiting for the control PSG.

Thank you to all the colleagues in the three hospitals in Madrid that did participate.

1Thottam PJ, Govil N, Duvvuri U, Mehta D. Transoral robotic surgery for sleep apnea in children: Is it effective? Int J Pediatr Otorhinolaryngol. 2015 Dec;79(12):2234-7. doi: 10.1016/j.ijporl.2015.10.010. Epub 2015 Oct 17. PMID: 26518466

2Venkatakarthikeyan C, Nair S, Gowrishankar M, Rao S. Robotic Surgery in Head and Neck in Pediatric Population: Our Experience. Indian J Otolaryngol Head Neck Surg. 2020 Mar;72(1):98-103. doi: 10.1007/s12070-019-01768-x. PMID: 32158664

3Rahbar R, Ferrari LR, Borer JG, Peters CA. Robotic surgery in the pediatric airway: application and safety. Arch Otolaryngol Head Neck Surg. 2007 Jan;133(1):46-50; discussion 50. doi: 10.1001/archotol.133.1.46. PMID: 17224522

4Kayhan FT, Yigider AP, Koc AK, Kaya KH, Erdim I. Treatment of tongue base masses in children by transoral robotic surgery. Eur Arch Otorhinolaryngol. 2017 Sep;274(9):3457-3463. doi: 10.1007/s00405-017-4646-0. Epub 2017 Jun 17. PMID: 28625010

5Zdanski 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. doi: 10.1002/lary.26101. Epub 2016 Jun 19. PMID: 27320495

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