“Transoral Robotic Surgery of the Skull Base: A Cadaver and Feasibility Study.”
Lee, J. Y., B. W. O’Malley, Jr., et al. (2010).
ORL; Journal of Oto-Rhino-Laryngology and Its Related Specialties 72(4): 181-187.
Objective: The goal of this study was to determine the potential role as well as the current limitations of the da Vinci Surgical System robot in transoral surgery of the skull base. Methods: The da Vinci robot was used to perform dissections of the skull base on 7 cadaver heads with their neck and clavicles intact. Neurosurgeons and otolaryngologists familiar with all facets of the open microscopic, minimally invasive, endoscopic and transoral robotic surgical procedure proceeded with the approach to and dissection of the human skull base. Results: The da Vinci robot provided superb illumination and 3-dimensional depth perception. The 30- degree endoscope improved cephalad visualization, and the ‘intuitive’ nature of the da Vinci surgical robot arms provided an advantage by their ability to suture the dura at the level of the clivus. An entirely transoral route provides access to the middle and lower clivus as well as the infratemporal fossa, but access to the sellar region and anterior cranial fossa is limited via a purely transoral route. Tremor-free dural closure was successfully performed. Conclusion: Our findings suggest that transoral robotic surgery utilizing the da Vinci robot system holds great potential for skull base surgical resection of extradural and intradural tumors of the middle and lower clivus and infratemporal fossa. A collaborative approach with neurosurgeon and otolaryngologist alternating at the master console and bedside is a successful strategy. Further instrument development is necessary, and continued investigation is warranted.
“Feasiblity of transoral robotic hypopharyngectomy for early-stage hypopharyngeal carcinoma.”
Park, Y. M., W. S. Kim, et al. (2010).
Oral Oncology 46(8): 597-602.
Conventional surgical approaches for hypopharyngeal carcinomas have a great risk for developing treatment-related morbidity. To minimize this morbidity, hypopharyngectomy by transoral robotic surgery (TORS) was performed, and the efficacy and feasibility of this procedure were evaluated. TORS was performed using da Vinci Surgical Robot (Intuitive Surgical Inc., Sunnyvale, CA) in 10 patients with T1 or T2 pyriform sinus cancer and posterior pharyngeal wall cancer. FK retractor (Gyrus Medical Inc., Maple Grove, MN) was used for transoral exposure of the lesion. A face-up 30-degree endoscope was inserted through the oral cavity and two instrument arms were located in both sides of the endoscope. Pyriform sinus was totally resected as a cone-shape from the vallecular to apex region, and ipsilateral arytenoid cartilage was saved for function preservation. The aryepiglottic fold was resected medially. Laterally, the inner perichondrium of the thyroid cartilage was peeled off after perichondrium was incised horizontally to make sure of the safe margin of antero-lateral portion. The posterior margin is an inferior constrictor muscle of the posterior pharyngeal wall. We evaluated the robotic set up time, robotic operation time, blood loss, surgical margins, swallowing time, decannulation time, and surgery related complications. Transoral robotic hypopharyngectomy was performed successfully in all 10 patients. The mean robotic operation time was 62.4min, and an average of 17.5min was required for the setting of the robotic system. There was no significant perioperative complication in the cases. Swallowing function returned to all patients within 8.3days average. Decannulation was carried out within an average of 6.3days after surgery. Transoral robotic hypopharyngectomy was feasible and ontologically safe technique for the treatment of early hypopharyngeal cancer.
“Transoral robotic-assisted thyroidectomy: A preclinical feasibility study in 2 cadavers.”
Richmon, J. D., K. M. Pattani, et al. (2010).
Head and Neck.
BACKGROUND: Technological advances in thyroid surgery have included various “minimally invasive” thyroidectomy techniques, both open and endoscopic. These include not only minimally invasive video-associated approaches but also variations of the transaxillary approach. More recently, a transoral technique using video assistance has been reported for thyroidectomy. Use of the robot was also recently published in a transaxillary approach to the thyroid. We hypothesized that the robot in combination with the previously described transoral technique would facilitate this novel surgical approach. METHODS: In 2 human cadavers the da Vinci robot was used to perform a transoral thyroidectomy. The dissection was performed with successful removal of the thyroid gland through the floor of the mouth. RESULTS: A total thyroidectomy was performed in 2 cadavers using the da Vinci robot transoral technique. The recurrent laryngeal nerve was preserved. CONCLUSIONS: Transoral robotic-assisted thyroidectomy (TRAT) provides an attractive approach to the central compartment for thyroidectomy in a field of “minimally invasive” and “scarless” techniques. (c) 2010 Wiley Periodicals, Inc. Head Neck, 2010.