Endoscopic resection of the submandibular gland in a porcine model

Objective: To examine the feasibility of endoscopic resection of the submandibular gland in a porcine model. Study Design. Experimental, nonrandomized prospective study. Methods: Twelve endoscopic submandibular gland resections were performed on seven Yorkshire adult pigs using a combination of balloon dissection and low-pressure CO2 insufflation. The operative time, blood loss, blood pressure, oxygen saturation, temperature, arterial blood gas values, and weight of the glands were measured. Results: All 12 submandibular gland resections were successfully performed endoscopically, and no conversions to open resection were necessary. The procedures lasted 42 to 140 minutes (median duration, 59 min). The median estimated blood loss was 15 mL. The submandibular glands weighed 13.3 +/- 1.5 g. The arterial blood pH varied from a decrease of 0.08 to an increase of 0.09 units from the beginning to the end of the operation. Similarly, the arterial CO2 pressure at the end of the case varied from a decrease of 15.8 to an increase of 16.2 mm Hg from the starting value. The presence of normal glandular architecture and lack of trauma or thermal injury were confirmed histologically. There were no cases of pneumothorax or air embolism, and no animals had to be killed. In one animal, a modest amount of subcutaneous emphysema could be appreciated, which was confined to the area over the operative pocket. Conclusion: Endoscopic resection of the submandibular gland is possible by combining balloon dissection with low-pressure CO2 insufflation, thereby avoiding complications of high-pressure insufflation such as pneumothorax and air embolism.