Transoral robotic surgery (TORS): glottic microsurgery in a canine model.
OBJECTIVE
We hypothesize that bimanual, three-dimensional robotic surgery will prove valuable for glottic microsurgical procedures.


METHODS
To test this hypothesis, we developed and optimized a canine model for glottic microsurgery using a commercially available surgical robot. Methods Using a da Vinci Surgical Robot (Intuitive Surgical, Inc., Sunnyvale, CA), glottic microsurgery was performed with a hydrodissection technique in a canine model. The experiments were performed on two orotracheal intubated mongrel dogs under general anesthesia in the supine position on a standard operating room table. A videoscope and two, 360-degree rotating, 5- and 8-mm, wrested-end effector instruments were introduced transorally with three robotic arms. The surgeon performed the actual procedures while positioned at a robotic system console that was located across the operating room suite. The procedure was performed in duplicate and was documented with still and video photography.


RESULTS
Glottic microsurgery was successfully performed using the da Vinci Surgical Robot, with both 5- and 8-mm instrumentation. The smaller, 5-mm instruments afforded greater visualization of the operative site and increased maneuverability, which resulted in reduced operative time. The robotic system provided excellent visualization as well as controlled and delicate microdissection at the vocal cord level.


CONCLUSIONS
Robotic laryngeal microsurgery is technically feasible in the canine model and warrants consideration for evaluation in controlled human trials.
Department of Otorhinolaryngology--Head and Neck Surgery, The University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA. bert.omalley@uphs.upenn.edu
Bert W
BW
O'Malley
Gregory S
GS
Weinstein
Neil G
NG
Hockstein
D000818:Animals; D004285:Dogs; D005931:Glottis / Q000601:surgery*; D006488:Hemostasis, Surgical; D007822:Laryngeal Neoplasms / Q000601:surgery; D007828:Laryngoscopy; D008866:Microsurgery / Q000379:methods*; D019060:Minimally Invasive Surgical Procedures; D023421:Models, Animal; D012371:Robotics / Q000295:instrumentation*; D013997:Time Factors; D014743:Videotape Recording