Transoral robotic surgery for bilateral parenchymal submandibular stones: the Flex Robotic System

Traditional management of the submandibular gland stones is based on transcervical sialadenectomy. Recently, conservative treatments emerged. In particular, transoral robotic surgery (TORS) has been used for the removal of submandibular sialoliths. Previous case series of TORS reported the use of the Da Vinci system with a high success rate. We describe an uncommon case of bilateral hilo-parenchymal submandibular stone removed via transoral approach with the Flex Robotic System. We report the step-by-step procedure for the transoral robotic approach to hilo-parenchymal submandibular sialoliths through the oral floor. The procedure was successful without complications. The total procedure time was 130 minutes, including 20 minutes for the robotic setting. The Flex Robotic System appeared to be a safe conservative surgical tool for hilo-parenchymal submandibular sialoliths by simultaneously preserving submandibular glands and avoiding severe complications on anatomical structures of the oral floor.