Salivary gland surgery Salivary gland surgery performed at St. Paul’s by Dr. Robert Irvine (left) and senior ENT resident, Dr. Josh Gurberg. Dr. Irvine has been invited to film one of his surgeries for webcast at one of his field’s top learning conferences.

Salivary gland procedure by St. Paul’s surgeon Dr. Robert Irvine to be webcast at global conference in Geneva

August 24th, 2017

Procedure will be webcast August 30 at European Sialendoscopy Training Centre

Most of us have never heard of “salivary stones.” But as you are probably guessing, yes, they are similar to kidney stones, albeit much smaller. Unless you’ve experienced it, you can’t imagine the discomfort such deposits are capable of causing in an area as sensitive as your salivary glands.

Unlike kidney stones, salivary stones don’t leave your body on their own. An otolaryngological surgeon with a specialty in the salivary glands has to remove them. Removing the stones is a relatively recent surgical advance. Not so long ago, the only option for a patient with salivary stones was removal of the gland.

Tiny surgical tools lead the way

The medical advances have been technology-driven: endoscopes tiny enough (one-thirtieth of an inch in diameter) to fit into your salivary ducts have revolutionized surgical procedures within this delicate environment.

One of the leaders in the field, St. Paul’s salivary gland surgeon Dr. Robert Irvine, has seen much of this technological arc, having been just out of medical school when change was in the air. He even experienced, first hand, its rocky beginnings.

Dr. Irvine recalls an ENT doctor (Ears, Nose, Throat) in White Rock in the early nineties who had read about a urology scope, acquired one, used it on a patient and got their stone out. Intrigued, Dr. Irvine asked if he could bring a patient of his to White Rock to try the scope. His friend agreed.

“Sure enough, we found the stone,” says Dr. Irvine. “But we had no way to get it out. So we started to tap away at it with a small tool to try to break it up. We did this for about two hours but we could not flush out the pieces of stone and, a few days later, I ended up removing the gland. But that day was a learning experience.”

A decade later, Dr. Irvine was perusing a medical journal and saw an ad for a piece of endoscopic equipment along with a course in Geneva on endoscopes.

“I found it heartening to see that others had seen the potential of endoscopic surgery in the salivary glands and over the years had been developing the instrumentation,” says Dr. Irvine. “I attended that Geneva event for the first time in 2003 and decided then that this is what I wanted to do.”

A gift that keeps on giving

As he began to seek funding at St. Paul’s to buy the endoscopic equipment he would need, Dr. Irvine encountered the usual budget challenges around hospital priorities, which he understood: his was a relatively small patient population so there were many needs above his, from the critical to the everyday, that simply took priority.

Dr. Irvine’s first endoscope, as it turned out, was purchased thanks to a gift from Mark and Barbara Cullen, long-time friends and supporters of St. Paul’s. And while Dr. Irvine has since acquired additional endoscopes, that first one from the Cullen family, ten years on, is still used today.

“I don’t know if I would have ever received the funding to get what I needed,” says Dr. Irvine, “and if I did get it via the usual budget route, it would have taken several more years. And again, it may never have happened at all. So that shows you the power of a donation. That original gift from the Cullens is why this program is where it is today.”

The Cullen family gift also led to a milestone when, in 2005, Dr. Irvine performed Canada’s first endoscopic laser surgery to remove salivary stones.

Dr. Irvine credits St. Paul’s for its support of his work and also names Dr. Joel Teichman, who is a pioneer in laser surgery for ureteric stones, which are similar to kidney stones and which block the flow of urine in the duct (the ureter) that connects the kidney and the bladder.

“We borrow a lot and have learned a lot from urology,” says Dr. Irvine. “The stones are similar. We use a lot of the same equipment, including the same laser. We go along the salivary duct as the urologist goes along the ureter. So Joel was a huge help to me, as was Sandra Swanson, who at the time was head of biomedical engineering for Providence Health Care and who taught me a great deal about issues like laser safety.”


Dr. Irvine attended his first sialendoscopy conference in Geneva in 2003 and has attended five in total. While he has been a part of the faculty and has taught there several times, this year conference organizers asked if he would record one of his procedures which they would then show to conference delegates, both those in attendance in Geneva as well as others watching in other countries.

“It’s one of our field’s premiere learning conferences,” says Dr. Irvine. “It’s an honour to be asked.”

Dr. Irvine’s procedure will be webcast on Wednesday, August 30.

You can make a donation to support patient care, research and equipment needs at St. Paul’s now by clicking the donate now button below. Remember the Cullen family gift and the impact it had, and still has. Please be as generous as you can!



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