Robot-assisted sialolithotomy with sialoendoscopy: a review of safety, efficacy and cost.

OBJECTIVE: Review the safety, efficacy and cost of robot-assisted sialolithotomy with sialoendoscopy (RASS) for large submandibular gland hilar sialoliths. STUDY DESIGN: Retrospective case series. METHODS: Patients ≥18 years diagnosed with submandibular hilar sialolithiasis between 1/1/2015 and 7/31/2018 who underwent RASS were identified. Procedure success, post-operative complications, procedure duration, and costs associated with the procedure were reviewed. RESULTS: 33 patients fit inclusion criteria. 94% of patients had successful sialolith removal. Mean sialolith size was 8.9 mm. 15.1% had transient tongue paresthesia. 0% had permanent tongue paresthesia compared to a 2% rate of lingual nerve damage cited in the literature for combined approach sialolithotomy (CAS). The average total cost was $16,921. Insurance paid 100%, 90-99%, 70-89.9%, and 40-69.9% of the expected reimbursement in 43.8%, 18.7%, 18.7% and 12.5% of patients respectively. 6% of patients self-paid. Compared to CAS, the cost of reusable robotic arms and drapes totaled $475, though these costs were included in the standardized operative cost per minute and were not forwarded to the patient. The mean procedure time was 62 minutes. Compared to published mean procedure times for CAS, the reduced operative time may account for a savings of $3332-$6069. CONCLUSION: RASS is a safe modality for submandibular hilar sialolith removal with a high success rate, low risk for temporary tongue paresthesia, and lower rate of permeant lingual nerve damage compared to CAS. Compared with CAS, RASS may result in a net reduction of operative room costs given its shorter procedure time.

Costs of sialendoscopy and impact on health-related quality of life.

PURPOSE: To analyse costs related to the diagnosis and treatment of patients with sialolithiasis and sialadenitis managed with sialendoscopy, and to prospectively evaluate the impact of sialendoscopy on health-related quality of life (HRQoL) in a longitudinal follow-up study. METHODS: All patients undergoing sialendoscopy or sialendoscopy-assisted surgery at a tertiary care university hospital between January 2014 and May 2016 were identified from a surgical database, and the direct hospital costs were retrospectively evaluated from 1 year before to 1 year after the sialendoscopy. The 15D HRQoL questionnaire and a questionnaire exploring the use of health care services during the preceding 3 months were mailed to the patients before sialendoscopy as well as at 3 and 12 months after the operation. RESULTS: A total of 260 patients were identified. Mean total hospital costs, costs related to the sialendoscopy, and complications were significantly higher in sialolithiasis patients than in patients with other diagnoses. 74 patients returned the baseline 15D questionnaire, and 51 patients all three 15D questionnaires. At baseline, the dimensions "discomfort and symptoms" and "distress" were lower in patients than in age- and gender-standardised general population, but the total 15D score did not differ significantly. The dimension "discomfort and symptoms" improved significantly at 3 and 12 months postoperatively, and the mean total HRQoL score improved in patients with sialolithiasis at 3 months postoperatively. CONCLUSIONS: The costs related to sialendoscopy are substantial and the cost-effectiveness of sialendoscopy warrants further studies. However, sialendoscopy seems to reduce patients' discomfort and ailments and to improve HRQoL at least in patients with sialolithiasis.

Outcome and relative cost of transoral removal of submandibular calculi.

OBJECTIVE: To examine the outcomes and treatment cost of transoral removal of submandibular calculi, and to compare the outcomes and costs of other reported techniques. METHOD: Retrospective review of 60 consecutive patients undergoing transoral removal of submandibular calculi. All clinical, operative, post-operative and follow-up data were collated and outcomes analysed. RESULTS: A total of 61 submandibular glands were treated by the transoral approach. Patients with multiple stones (p = 0.034) and stones in the proximal submandibular duct (p = 0.0028) were at greater risk of requiring submandibular gland excision, compared with patients with single stones and stones in the distal duct, respectively. There was a significant difference between the gland preservation rate during the first versus the second half of the study (p = 0.028). Larger calculi were significantly more likely to be seen in the proximal duct (p < 0.001). The mean operating time (28 minutes) and length of hospital stay for transoral removal of submandibular calculi was much less than those for other treatment techniques.

Symptomatic sialoadenitis and sialolithiasis in the English population, an estimate of the cost of hospital treatment.

OBJECTIVE: To establish the annual incidence, and cost of treating, symptomatic salivary stones and sialoadenitis. MATERIALS AND METHODS: Data relating to sialolithiasis and sialoadenitis were obtained from the Department of Health with respect to the 15 health regions in England during the period 1991-1995. These were analysed to obtain the mean incidence per annum. The proportions of each condition treated on an in-patient and out-patient basis were also calculated. A survey of hospital fees was undertaken to determine the national cost for treating these two conditions. RESULTS: In the period the mean incidence of hospital admission for symptomatic sialoadenitis and sialolithiasis in the 15 health regions in England was 27.5 (19-46) and 31.5 (26-37) per million population per annum respectively. During this time there was a slight shift toward day case treatment. CONCLUSIONS: Based on hospital admission data for the period 1991-1995 the mean incidence of symptomatic sialolithiasis is relatively low, being at least 27 per million population per annum and possibly as much as 59 per million population per annum. This represents a cost to the National Health Service of up to 4,000,000 Pounds per annum.