A first exploration of the economic consequences of an autonomous surgical robot for lateral skull base surgery: an early health technology assessment

OBJECTIVES

Lateral skull base procedures, such as translabyrinthine approach (TLA), are challenging. An autonomous surgical robot might be a solution to these challenges. Our aim is to explore in an early phase the economic consequences of an autonomous surgical robot compared with conventional TLA.

METHODS

An early decision analytic model was constructed in order to perform a step-wise threshold analyses and a sensitivity analysis to analyze the impact of the several factors on the incremental costs.

RESULTS

Using surgical robot results in incremental costs - EUR 5,562 per procedure - compared to conventional TLA. These costs are most reduced by higher number of procedures, followed by lower price of the robot, saved operation time, and reduced risk of complication, respectively.

CONCLUSIONS

The incremental costs of using an autonomous surgical robot can be decreased by choosing applications with a high turnover rate, a long operation time, and a high complication rate.

Evaluation of subclasses for T4-classified squamous cell carcinoma of the external auditory canal

Background

T4‐classified squamous cell carcinoma (SCC) of external auditory canal (EAC) can potentially involve different anatomical structures, which could translate into different treatment strategies and survival outcomes within one classification. Our aim is to evaluate the clinical added value of T4‐subclasses proposed by Lavieille and by Zanoletti.

Methods

Retrospective data, including patients with primary operated cT4‐classified EAC SCC, was obtained from 12 international hospitals. We subclassified according to the T4‐subclasses. The treatment strategies, disease‐free survival (DFS) and overall survival per subclass were calculated.

Results

A total of 130 T4‐classified EAC SCC were included. We found commonly used treatment strategies per subclass according to Lavieille and the DFS seems also to differ per subclass. Subclass according to Zanoletti showed comparable treatment strategies and survival outcomes per subclass.

Conclusion

Our study suggests that the subclass according Lavieille might have added value in clinical practice to improve care of T4‐classified EAC SCC.

Facial nerve palsy due to a parotid abscess: Two case reports and a review of literature

Introduction and importance

Parotid gland swelling with facial nerve palsy is highly suggestive of a malignancy. Facial nerve palsy is however rarely caused by a parotid abscess. We hereby present two cases, propose treatment and present a review of the literature.

Case presentation and clinical discussion

One 75-year-old female and one 81-year-old female presented with a facial nerve paralysis, both caused by a parotid gland abscess. Broad-spectrum antibiotics and incision and drainage was commenced in both cases. Both patients showed good clinical improvement, however, without facial nerve improvement. Magnetic resonance imaging (MRI) scans showed no malignancies at presentation nor during follow-up after one year.

Conclusion

Facial nerve palsy is rarely caused by a parotid abscess. Incision and drainage in combination with antibiotic treatment is recommended. Chances of facial nerve recovery seem somewhat higher in patients with facial nerve paresis than those with a paralysis.

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Case report on a parotid abscess being a rare cause of facial nerve palsy

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Malignancy needs to be ruled out in facial nerve palsy and parotid gland abscess.

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Facial nerve paresis has higher recovery chances compared to facial nerve paralysis.

Evaluation of the modified Pittsburgh classification for predicting the disease-free survival outcome of squamous cell carcinoma of the external auditory canal

Background

Squamous cell carcinoma (SCC) of the external auditory canal (EAC) is a rare disease, which is commonly classified with the modified Pittsburgh classification. Our aim was to evaluate the predictive performance of this classification in relation to disease‐free survival (DFS).

Methods

We examined retrospective data from a nationwide Dutch cohort study including patients with primary EAC SCC. These data were combined with individual patient data from the literature. Using the combined data, the predictive performances were calculated using the c‐index.

Results

A total of 381 patients were included, 294 for clinical and 281 for the pathological classification analyses. The c‐indices of the clinical and the pathological modified Pittsburgh classification predicting DFS were 0.725 (0.668‐0.782) and 0.729 (0.672‐0.786), respectively.

Conclusion

The predictive performance of the modified Pittsburgh classification system as such appears to be acceptable to predict the DFS of EAC SCC. Other factors need to be added to a future model to improve the predicted performance.

Treatment of Recurrent Eczematous External Otitis with Honey Eardrops: A Proof-of-Concept Study

Eczematous external otitis is a chronic inflammatory disease and often difficult to treat. Our objective was to investigate the clinical effect and in vitro antibacterial potential of medical honey eardrops as treatment of eczematous external otitis. In a prospective study, 15 patients diagnosed with recurrent eczematous external otitis were treated with medical honey eardrops for 2 weeks. The following clinical outcomes were evaluated: visual analog scale of ear complaints, score of eczema, and eradication of bacterial infection. Furthermore, the antibacterial effect of honey eardrops against different bacterial strains was tested in vitro. Treatment resulted in less discomfort and itching and decreased signs of eczema, with high patient satisfaction and without adverse reactions. Honey eardrops showed a strong in vitro inhibitory activity against all tested strains but did not eradicate Staphylococcus aureus infection in vivo. The results of this preliminary study indicate a possible role of honey eardrops in eczematous ear disease.