Outcomes of endoscope-assisted and robot-assisted submandibular sialadenectomy: a systematic review and meta-analysis

Endoscope-assisted submandibular sialadenectomy (EASS) and Robot-assisted submandibular sialadenectomy (RASS) are emerging as a minimally invasive alternative to conventional submandibular gland (SMG) resection. This review aims to evaluate the feasibility and perioperative outcomes of EASS and RASS.

A literature search was conducted in PubMed, Embase, and Cochrane Library for studies on EASS or RASS outcomes up to July 2024. Outcomes of interest included operative time, intraoperative bleeding, incision length, satisfaction, and facial nerve injury. Other complications besides facial nerve injury were also documented.

Eighteen studies involving 364 patients were included. The operation time and incision length in the endoscopic-assisted group were longer than those of conventional group, but the postoperative satisfaction was higher. There were no significant differences in drainage volume, length of hospital stay, and postoperative complications between the two groups. In addition, subgroup analyses within the single-arm meta-analysis were performed for the operation time, wound length, length of hospital stay, complications of EASS and the operation time, drainage volume, length of hospital stay of RASS (MD = 96.06, 95% CI 81.84-110.27; MD = 35.08, 95% CI 9.61-60.56; MD = 3.6, 95% CI 1.6-5.5; OR 0.11, 95%CI: 0.01-0.2; MD = 85.6, 95% CI 53.5-117.6; MD = 208.87, 95% CI - 2.43-420.17; MD = 3.31, 95% CI 3.15-3.47).

EASS appears to be a feasible and safe surgical procedure for patients with SMG lesions. Compared with open SMG resection, EASS showed a longer operative time and incision length, but higher cosmetic satisfaction.