Phd in ADVANCED SURGICAL TECHNOLOGIES

Thesis title: Litotrissia laser intraduttale con Holmium-YAG laser per le ghiandole salivari maggiori. Anestesia locale o anestesia generale?

Introduction Intraductal lithotripsy of the major salivary glands using a Holmium:YAG laser allows treatment of large stone in sialolithiasis (4-8 mm). In the current scintific literature the majority of papers includes patients who underwent laser lithotripsy under general anesthesia, which is considered the standard of care, even though the surgical procedure is only slightly more invasive than a diagnostic or operative sialoendoscopy. In recent years, there has been an increase in “in-office” surgical procedures performed under local anesthesia or sedation in order to decrease hospital stays in mini-invsive surgery, to reduce costs of hospitalizzation, and shorten surgical waiting lists. The objective of this work is to compare the efficacy of intracorporeal lithotripsy of the major salivary glands with Holmium:YAG laser performed under local anesthesia (LA) versus general anesthesia (GA). Matherials and methos A retrospective observational study was conducted on a group of patients who, between January 2017 and June 2025, underwent intraductal lithotripsy for salivary gland stones using a Holmium:YAG laser under either general or local anesthesia at the University ENT Department (UOC) of the ASL of Latina. Pediatric patients and those who had previously undergone salivary stone removal by intraductal fragmentation (pneumatic or laser) or who had undergone surgery of the oral floor or neck were excluded from the study. Results A total of 34 patients underwent Holmium:YAG laser lithotripsy for major salivary gland stones. Four patients were excluded from the study due not meeting the inclusion criteria, leaving a total of 30 patients. After data collection, the patients were divided into two groups: 16 treated under general anesthesia (GA) and 14 under local anesthesia (LA). In the LA group, a therapeutic success rate of 71.4% was observed, while in the GA group, it was 87.5%. No statistically significant differences were found between the two groups (GA vs LA) in terms of therapeutic success (p = 0.387), duration of the surgical procedure (p = 0.084), occurrence of complications (p = 0.586), or postoperative pain (p = 0.634). Conclusion Intraductal lithotripsy with the Holmium:YAG laser for the treatment of lithiasic disease of the major salivary glands performed under local anesthesia, if possible, represents an effective and safe therapeutic option. Increasing the use of this technique could lead to a reduction in costs for both the patient and the healthcare system, as well as a decrease in waiting times for treatment.