Transoral robotic surgery versus conventional transoral surgery for submandibular stones: Systematic review and meta-analysis

Purpose: The recent diffusion of transoral robotic surgery has prompted its application not only in the oropharyngeal and hypopharyngeal-laryngeal fields, which are the anatomical sites of major use of the method, but also in the oral floor for the removal of tumours and other diseases affecting the salivary glands, such as sialothiasis. This study aims to assess the safety and efficacy profiles of transoral robotic surgery compared to traditional transoral procedures for the treatment of submandibular stones. Methods: PubMed, Embase, and Web of Science were searched for studies reporting on traditional or robotic transoral surgery for submandibular stones. As recommended by the PRISMA guidelines, proportion meta-analysis was performed on a random-effects model. The present review was registered on PROSPERO (CRD42024522199). Results: A total of 2520 participants from 23 studies were included. The selected patients had a mean age of 44 years (range 5-87), with 48 % of them being female. Transoral robotic surgery had a success rate of 95.7 % (95 % CI 90.9-99.0), higher than traditional transoral approaches (success rate 92.6 %; 95 % CI 89.3-95.4). Transient stupor of the lingual nerve was observed more frequently in robotic surgeries (15.8 % vs 8.1 %). However, no reports of permanent injury to the lingual nerve were found. Conclusion: Transoral robotic surgery is a valid treatment option for submandibular stones. Due to the high costs of the procedure, strict patient selection is mandatory.