Recent progress of retroauricular robotic thyroidectomy with the new surgical robotic system.

OBJECTIVE: Previously, we have reported the feasibility of retroauricular (RA) robotic thyroidectomy. Despite its promising surgical outcomes, there were certain intrinsic mechanical limitations inherent to the da Vinci Si System (Intuitive Surgical, Sunnyvale, California, U.S.A.). Since the advent of an upgraded model, the Xi System (Intuitive Surgical), we have actively incorporated the new model into performing RA thyroidectomy. Here, we intend to verify the feasibility of RA robotic thyroidectomy using the new da Vinci Xi System (Intuitive Surgical) with comparison of the former Si-applied surgery (Intuitive Surgical). STUDY DESIGN: Comparative analysis. METHODS: There were total 165 consecutive patients who received RA robotic thyroidectomy from January 2013 to February 2016. The patients were divided into two groups: Si group (n = 125) and Xi group (n = 40). Perioperative and treatment outcomes were compared and analyzed. RESULTS: Compared with the previous system, new da Vinci Xi system (Intuitive Surgical) enabled insertion of an extra third robotic instrumental arm. Unlike the previous robotic surgical technique, the robotic dissection could be initiated immediately after the establishment of working space and the resulting total operation time could be significantly decreased. There was no difference in the surgical completeness, as confirmed by postoperative thyroglobulin levels. Additionally, flexed EndoWrist (Intuitive Surgical) instruments equipped with the Erbe (Erbe USA Inc., Marietta, Georgia, U.S.A.) system could be mounted, which further facilitated the operation. There were no significant differences in postoperative complications between the two groups. CONCLUSION: The RA robotic thyroidectomy with the new Xi System (Intuitive Surgical) can greatly facilitate the robotic surgery with comparable or improved surgical outcomes. Its application is expected to open up a new era of robotic neck surgery. LEVEL OF EVIDENCE: 4. Laryngoscope, 128:1730-1737, 2018.

Evaluation of domestic and Yucatan swine nasal sinus anatomy as models for future sinonasal research of medications delivered by standard instruments used in functional endoscopic sinus surgery.

BACKGROUND: There is a need to find an animal model to study new medications to improve mucosal wound healing after functional endoscopic sinus surgery (FESS). Current literature suggests swine as a potential candidate. The lack of information correlating swine computer tomography (CT) and endoscopic sinonasal anatomy prompted us to investigate them in the domestic and Yucatan swine to determine their feasibility as models to test new medications and drug-embedded stents applied using FESS techniques. METHODS: Two domestic pig heads and 2 Yucatan pig heads were imaged using helical thin slice (1 mm) CT. Two rhinologists analyzed the images and performed endoscopy on the swine. Particular attention was given to accessing the frontal sinus and suturing stents to the nasal septum using standard endoscopic instruments. RESULTS: CT confirmed that swine sinonasal anatomy is largely similar to human, with all major sinuses present. The middle and inferior turbinates of swine arise from a single uniturbinate. The superior turbinates contain large concha bullosa. Unlike human, swine nasal septum is bone anteriorly and cartilage posteriorly. The frontal sinus ostia, regardless of head size, were consistently around 10 cm from the nasal aperture. On endoscopy, domestic swine frontal sinus ostia were easily accessible for topical medication deposition. Silastic splints can be sutured to the domestic swine septum through the posterior cartilaginous portion, allowing for studies involving medication-eluting material. The narrower nasal cavity of Yucatan pigs prohibited endoscopic maneuvers. CONCLUSION: Domestic swine, but not Yucatan, are a feasible model for future sinonasal research using standard FESS instruments.

A systematic review of pediatric sensorineural hearing loss in congenital syphilis.

INTRODUCTION: Congenital syphilis is a known cause of progressive sensorineural hearing loss. The prevalence of syphilitic sensorineural hearing loss (SNHL) in childhood is not clearly defined. OBJECTIVE: To determine the frequency and characteristics of pediatric SNHL following intrauterine infection with or exposure to Treponema pallidum in order to develop evidence-based guidelines for audiologic monitoring. DATA SOURCES: Medline (1950-March 2008), EMBASE (1980-March 2008), CINAHL (1982-March 2008), BIOSIS Previews (1969-March 2008), and Cochrane databases. Manual search of references of identified articles and book chapters. STUDY SELECTION: Articles with an inception cohort of children infected with T. pallidum during pregnancy, positive serological identification of syphilis infection in the antenatal period or pathognomonic clinical signs of congenital syphilis infection, and longitudinal serial audiologic evaluations to identify the prevalence and progression of SNHL. DATA EXTRACTION: Patient information, maternal and infant serologic status, and audiometric data extracted in an independent fashion. Discrepancies resolved through mutual consensus. DATA SYNTHESIS: Descriptive statistics. RESULTS: One prospective cohort study met the inclusion criteria. No cases of SNHL in infants with early congenital syphilis treated with antibiotics in the neonatal period were identified. CONCLUSIONS: There have been no reports of children with confirmed congenital SNHL secondary to in utero syphilis infection. Newborns with positive syphilis serology should have hearing screening performed at birth and receive treatment with an appropriate course of penicillin therapy. Longitudinal hearing screening is recommended for all pediatric patients with congenital syphilis, as further studies documenting longitudinal audiometric data for patients previously treated either fully or partly for congenital syphilis are required.