The rPTH assay is a highly accurate and effective tool for predicting symptomatic hypocalcemia immediately after thyroidectomy. Routine utilization of this assay is recommended, because it will allow safe and timely discharge of normocalcemic patients and the early identification of patients requiring treatment of postthyroidectomy hypocalcemia.

The da Vinci Surgi cal System is a new and exc iting entrant into thefi eldof robotic technology. This sys tem is undergoing considerable research and is being pra ctically appli ed in general surgery, cardiothoracic surgery, urology, and gyneco logy. Wehave previo usly described our experience with the da Vinci sys tem in the laboratory selling, and we have revieweditspotential app licatio ns in otolaryngology. Here we present a case report ofthefirs t da Vinci-assisted excision of a vallecular cyst in a human. Although we initially encountered some difficulties in the setup , we were able to perform the proc edure with moderate ease and without complication. The p otential of the da Vinci sys tem in otolaryngology is prom ising. Further research is needed to exp lore all of its p ossible uses in ourfield.

Posterior epistaxis is a significant medical problem that can be challenging to treat. Endoscopic surgery could potentially reduced operative time and patient risk; however, surgeons report difficulty in endoscopically isolating the major offending artery, the sphenopalatine. These difficulties could be reduced if a recognizable anatomic structure marked the region of the artery. The study objective is to characterize the relationship of a relatively unknown anatomic structure, the crista ethmoidalis, to the sphenopalatine foramen/artery, in an effort to facilitate location of the sphenopalatine artery during endoscopic ligation. Using 22 human cadaveric sagitally sectioned heads and standard gross anatomic dissection techniques, the presence of the crista ethmoidalis was sought and recorded as well as its relative location to the sphenopalatine foramen/artery. The crista ethmoidalis was present and closely related to the sphenopalatine foramen and artery in all specimens. In 21/22 specimens, the crista was located just anterior to the sphenopalatine foramen, whereas in one specimen it was located 3 mm directly inferior to the foramen. Our investigation indicates that the crista ethmoidalis is a helpful and reliable landmark for endoscopically locating the sphenopalatine artery and foramen. Using this landmark, the initial problems reported with endoscopic ligation, i.e., locating the foramen and artery, should be greatly reduced. We offer our observations regarding the crista ethmoidalis to assist endoscopic surgeons in the care of their difficult epistaxis patients.

Anatom ic co nstraints and ins trumentation design characteristics ha ve limited the exp loitation ofendos copic surgery in otolaryngology. The move towa rd less invasive and less morbid p roced ures has pav ed the way f or the development and applicati on of robo tic and comp uter-assisted system s in surgery. Surgical robo tics all ows f or the use of new instrum entation in ourfield. We review the operative advant ages, limitations, and possible surgica l app lications of the da Vinci Surgica l System in otolaryngo logy. In the lab oratory setting, we exp lored the setup and use ofthe da Vinci sys tem in porcin e and cadave ric head and neck airwa y mod els; the setup was config ured fo r op tima l airway surgery. Endoscop ic ca utery, manipulation, and suturing of supraglottic tissu es were performed in both the porcin e an d cadave ric mod els. We fo und that the da Vinci sys tem p rovided the advant ages ofthe low er morbidity associated with endoscopic surgery, more f reedom of movem ent, and three-dimension al ope n surgical viewing. We also observed tha t the sys tem has se veral limitati ons to use in otolaryngology.

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