Surgical robotic applications in otolaryngology.
OBJECTIVE
To explore the feasibility of performing endo-robotic neck surgery in a porcine model and to compare the results of robotically enhanced endoscopic surgery with those from a conventional endoscopic technique.


METHODS
Prospective, nonrandomized experimental investigation in a porcine model.


METHODS
We performed a consecutive series of endoscopic neck surgeries using the daVinci surgical system (Intuitive Surgical Inc.). The length of time required to establish the operative pocket and to assemble the robotic components, as well as the total duration of each operation, was recorded. The animals were continuously monitored for heart rate, blood pressure, and end-tidal CO(2) pressure, and evaluation for presence of pneumothorax and subcutaneous emphysema was undertaken postoperatively. The specimens were examined histologically.


RESULTS
Four different types of neck surgery were successfully performed on both sides of the neck of four animals using the daVinci surgical system. Creation of the operative pocket took, on average (+/-SD), 18.1 +/- 11.9 minutes, and assembly of the robot required 12.5 +/- 9.9 minutes, resulting in a mean preparation time for all procedures of 30.6 +/- 21.0 minutes. The mean operative time for submandibular resection (n = 3) was 19.0 +/- 6.6 minutes, with a total procedure time of 39.0 +/- 10.2 minutes. Selective neck dissections (n = 3) required a mean operative time of 66.0 +/- 18.5 minutes and a total procedure time of 85.7 +/- 16.7 minutes. One partial parotidectomy and one thymectomy were also performed. The median estimated blood loss was 0 mL (range, 0-10 mL). The end-tidal CO(2) pressure fell from the start to the end of the procedures by a mean of 4.4 +/- 7.9 mm Hg. The blood pressure fell by a mean of 1.9 +/- 7.5 mm Hg. There was one case of modest subcutaneous emphysema, and there were no cases of pneumothorax or air embolism. No conversions to open resection were necessary.


CONCLUSIONS
Robotically enhanced endoscopic surgery in the neck is feasible and offers a number of compelling advantages over conventional endoscopic neck surgery. Clinical trials will be necessary to determine whether these advantages can be achieved in clinical practice.
Haus
Brian M
BM
School of Medicine, Stanford University Medical Center, Stanford, CA, USA.
Kambham
Neeraja
N
Le
David
D
Moll
Frederic M
FM
Gourin
Christine
C
Terris
David J
DJ
D000818:Animals; D016063:Blood Loss, Surgical; D004724:Endoscopy; D005240:Feasibility Studies; D005260:Female; D006439:Hemodynamics; D009333:Neck / Q000601:surgery*; D037981:Neck Dissection; D013517:Otorhinolaryngologic Surgical Procedures / Q000295:instrumentation / Q000379:methods; D010306:Parotid Gland / Q000601:surgery; D011183:Postoperative Complications; D012371:Robotics; D013363:Submandibular Gland / Q000601:surgery; D013552:Swine; D013934:Thymectomy