Endoscopic Neck Surgery: Resection of the Submandibular Gland in A Cadaver Model

Objectives/Hypothesis: The objective was to evaluate the feasibility of performing a totally endoscopic resection of the submandibular gland in a cadaver model. Study Design: Prospective, nonrandomized experimental investigation in a cadaver model. Methods: A modified endoscopic surgical approach (representing a hybrid of balloon dissection and low-pressure carbon dioxide insufflation) previously developed in a porcine model was implemented in fresh cadavers. Once a reliable protocol was achieved, eight procedures were performed in six cadavers. Data collected prospectively included the operative time, inadvertent neurovascular injury, and size of the glands. Results: All eight endoscopic submandibular gland resections were successfully performed in six consecutive cadavers (no conversions to open resection were necessary). The duration of the procedures ranged from 50 to 150 minutes, with a median duration of 65.5 minutes and a steady trend toward a shorter duration. Histological examination confirmed the presence of normal glandular architecture without evidence of excessive trauma or thermal injury. The optimal spacing of the instrument ports was 4 cm from the camera port. There were no cases of neurovascular injury. In two cadavers, a minimal amount of subcutaneous emphysema could be appreciated, which was limited to the skin overlying the dissection. Conclusion: Totally endoscopic resection of the submandibular gland is possible by combining balloon dissection with low-pressure carbon dioxide insufflation. The excellent visualization afforded by the endoscope provided a safe operative approach. Ultimately, a number of endoscopic neck procedures may be possible, and clinical trials are under way.