Standardization of Basket Use in Sialendoscopy: A Ten-Year Retrospective Study

The main purpose of this article is to standardize the basic steps involved in successfully removing intraductal sialolithiasis with the basket instrument. Doing this, we facilitate all the handling of the instruments, baskets, in cell endoscopes during cell endoscopy, making procedure highly safe and successful to the present year.

Within the last 20 years, we've advanced in the knowledge, scopes, and materials. We are capable of retrieving sialoliths, salivary stones, effectively by the cell endoscopy along or in combination with minimal invasive procedures, saving a functional salivary gland.

The biggest challenge is to achieving a high success rate of retrieving a salivary stone inside the duct with the minimal maneuvers possible and with lesser time consuming.

With our proposed protocol, we hope to help the beginner assistant physician to perform a high success rate sialendoscopy. The literature has no data reporting this type of standardization protocol in basket use, improving the technique and ensuring the safety.

Our finds will help to create a safe protocol in a basket used in sialendoscopy. Beyond this patient safe, one can use a protocol among different services, helping to create an international bank of data to evaluate the efficacy and safely of the technique, helping to train new physicians.

[Instructor] To begin, inspect the sialendoscopes and supporting instruments in a sterile field and verify the integrity of their materials. Using manual handling, test the basket operation outside the duct system after opening the wires, as per the manufacturer's instructions, connect the fiber optic cables to the video rack lighting system, and maintain light intensity at approximately 50%. Attach the other end of the fiber optic cable to the sialendoscope. Check the monitor screen for the presence of light and ensure proper image formation. Rotate the video image adjustment to focus and eliminate any honeycomb artifacts on the monitor screen. Use the wire packaging label to confirm that the image quality is optimal and the letters are legible. Identify the irrigation channel caudally, with the optical fiber centered and the working channel cranially positioned. Adjust the scope so the north orientation of the sialendoscope aligns correctly with the screen, using the wire label as reference. Connect a full sterile physiological 0.9% saline solution setup to the irrigation channel and ensure no air bubbles are present that could interfere with image formation inside the ductal system. Now, place the patient in the supine position under general anesthesia, with the orotracheal tube on the side opposite to the affected gland. Dilate the salivary gland papilla progressively with dilators until it fits the appropriate size of the sialendoscope, and then, insert the sialendoscope once proper size is achieved for clear duct visualization. Once the duct is distended, gently navigate the sialendoscope into it without using major maneuvers or twists. Using the sialendoscope, inspect the main, secondary, and tertiary ducts in detail. After cleaning, locate the salivary stone or stones inside the duct and prepare for stone capture maneuvers. Using the sialendoscope, inspect all duct extensions during the initial phase, checking for the presence of stenosis and evaluating it across the main, secondary, and tertiary ducts. Observe the appearance and location of any duct stenosis and estimate its size in comparison to the main duct. Also, look for stones located beyond the stenosis and assess the nature of the saliva, whether milky or clear. After the initial inspection, examine the main, secondary, and tertiary ducts directly to locate stones, making note of their exact positions within the ductal network. Observe the size of each sialolith carefully and document whether the stones occupy the full duct diameter or are smaller. Identify whether the stones are single or multiple and plan the approach accordingly as a single or multiple attempt retrieval. Flush the duct with sterile 0.9% physiological saline solution while maneuvering the sialendoscope to observe the stone mobility and classify them as fixed, minimally mobile, or freely mobile. Select the appropriate basket type, three-wire, four-wire, or six-wire, based on the size and mobility of the stone, ensuring a better chance of successful capture. After completing the prior evaluation, place the tip of the basket directly against or very close to the anterior part of the sialendoscope for the type A frontal approach. Open the wires gently and flush with sterile saline solution while attempting to trap the stone as it is carried into the basket. Select the type B side-to-side approach for relatively mobile single stones smaller than the duct diameter. Position the basket tip beside the stone, aligning the wires laterally. Gently flush with sterile saline solution and use soft lateral movement of the open basket to dislodge and capture the stone. Use the type C back-to-forward approach for stones that are as large as the duct or for fixed stones with low mobility. Position the basket tip posterior to the sialolith and open the wires behind it and bring the basket forward while flushing gently to wrap around the stone. Once the wires enclose the stone, pull the basket wires to secure the stone. Perform a final inspection of the main, secondary, and tertiary ducts before completing the procedure to check for residual stones or stenosis. Endoscopic stone extraction was successfully performed in 100% of the pure sialendoscopy group, with all patients also receiving intraductal steroids. Submandibular gland involvement was noted in 68.9% of patients. Most patients presented with pure stones, and parotid stones were observed in 31.1%. Single stones were identified in 65.9% of cases, while multiple stones were seen in 34.1%. No major complications occurred, and no infections, dehiscence, or stuck baskets were reported. The mean silent endoscopy duration was 62 minutes, ranging from eight to 98 minutes. Stones were localized in the main duct in 73.5% of cases, and 26.5% were in secondary or tertiary ducts. Basket types included four-wire baskets in 68.9% of cases, three-wire in 25.8%, and six-wire in 5.3%. The side-to-side technique was used in 35.6% of patients, while the back-to-forward technique was applied in 55.3%.