Sialendoscopy Updates: A Look at New Technology, Cost, and Frequency of Use

Newer Technologies

Great advancements have been made in sialendoscopy over the last few years. Salivary stone retrieval baskets have improved significantly, in both shape and overall design, which allows for a much easier and safer retrieval of imbedded salivary stones, said Michael D. Turner, DDS, MD, MS, chief of oral and maxillofacial surgery in the department of otolaryngology at Mount Sinai Hospital in New York City. A game-changing technology that’s currently being developed is sialolithotripsy, which allows surgeons to shatter a stone during sialendoscopy.

The key technology that has made sialendoscopy possible is the development of high-definition miniature scopes by endoscope manufacturer Karl Storz, which range in size from 0.8 mm to 1.6 mm, Dr. Walvekar said. The technology offers interventional channels through which physicians can perform procedures to manage problems within the salivary duct such as stones or stenosis.

Another major innovation is the development of a dilation and intubation kit for the salivary papilla and duct by Cook Medical USA, which has made it possible to have quick access to the duct, Dr. Walvekar said. In addition, Hood Laboratories USA has developed a salivary duct stent that allows stenting of the salivary duct in the presence of duct repair or stenosis, making it possible to comprehensively manage a variety of ductal system disease processes.

The sialendoscope is only one instrument within an array of management options for advanced care of the salivary glands, said Henry T. Hoffman, MD, MS, professor of otolaryngology in the department of otolaryngology at the University of Iowa in Iowa City. The improved application of ultrasound imaging—including sonopalpation and the use of ultrasound-directed interventions such as balloon dilation—offers two examples. Contemporary applied digital sialography has promoted this approach as the one that provides the best imaging of the ductal system. Sialography, when performed with iodinated radiocontrast with antimicrobial properties, has additionally served as a therapeutic intervention in selected cases.

Adding Sialendoscopy to a Practice

There are many aspects to address when incorporating sialendoscopy into a practice. A surgeon and their institution will need to be committed to investing time, capital, and energy to create this offering, Dr. Walvekar said. The surgeon, operating nursing staff, and team of instrument handlers will also need training. Both non-disposable and disposable equipment must be purchased, and vendor contracts will need to be established to allow surgeons to have a wide range of equipment at their disposal and facilitate quick replacement if a scope is damaged.

An endoscope costs between $7,500 and $10,000. They come in three or four sizes; Dr. Turner recommends having at least two of each size because they’re delicate and can easily break if improperly handled. Given their fragility, he recommends maintenance contracts for these scopes, which can be rolled into existing contracts for other endoscopes. Some instruments that have been developed, such as dilators, allow for a more efficient and quicker surgery. Stone retrieval baskets are roughly $300 each and can be used only once.

When adding up all of the necessary components to purchase a complete sialendoscopy set, expect to spend approximately $40,000, Dr. Hsu said. Renting a set for a single case runs approximately $3,000. A hospital facility may cover the costs, but that price tag would require a significant volume to justify purchasing a set.

Additionally, an institution will need to work with a surgeon and payers to create a streamlined way to track revenue and charges, and to ensure that reimbursement is appropriately captured. As an unlisted procedure, sialendoscopy requires some vigilance and diligence from the reimbursement team to capture revenue, Dr. Walvekar said.

Other investments include marketing and outreach to support a new practice or offering and creating awareness among a surgeon’s referral base regarding what sialendoscopy can offer patients, Dr. Walvekar said. Primary care providers, pediatricians, endocrinologists, rheumatologists, oral surgeons, dental practices, and general otolaryngology practices will be interested in learning more about how sialendoscopy can help their patients.