title: Robotic surgery in the pediatric airway: application and safety.
abstract: OBJECTIVE
  To assess the application and safety of transoral robotic surgery in the pediatric airway.
  
  
  METHODS
  An institutional review board-approved study. Experimental laryngeal surgery was performed on 4 pediatric cadaver larynxes as controls. Application of robotic equipment for laryngeal surgery was attempted on 5 patients.
  
  
  METHODS
  Tertiary care pediatric medical center.
  
  
  METHODS
  Five patients with laryngeal cleft and 4 pediatric cadaver larynxes.
  
  
  METHODS
  (1) The da Vinci Surgical Robot (Intuitive Surgical Inc, Sunnyvale, Calif) was used on 4 cadaver larynxes and assessed for the dexterity, precision, and depth perception that it allowed the surgeon during laryngeal surgery. Procedures were documented with still and video photography. (2) The da Vinci Surgical Robot was used through a transoral approach to attempt repair of a laryngeal cleft in 5 pediatric patients who were under spontaneously breathing general anesthesia.
  
  
  RESULTS
  (1) Use of the surgical robot on cadaver larynxes provided great dexterity and precision, delicate tissue handling, good 3-dimensional depth perception, and relatively easy endolaryngeal suturing. (2) The surgical robot could not be used for repair of laryngeal cleft on 3 patients owing to limited transoral access. However, 1 patient with a type 1 laryngeal cleft and 1 patient with a type 2 laryngeal cleft underwent transoral robotic repair with great success.
  
  
  CONCLUSIONS
  Surgical robots provide the ability to manipulate instruments at their distal end with great precision, increased freedom of movement, and excellent 3-dimensional depth perception. The size of the equipment can be a limiting factor with regard to the application and success of the transoral approach to airway surgery. We believe that further advances in device technology and a new generation of robotic equipment will facilitate the incorporation of surgical robotics in the advancement of minimally invasive endoscopic airway surgery.
authors.affiliation: Department of Otolaryngology and Communication Disorders, Anesthesia, and Urology, Children's Hospital Boston, Harvard Medical School, Boston, Mass, USA. reza.rahbar@childrens.harvard.edu
authors.forename: Reza
authors.initials: R
authors.lastname: Rahbar
authors.forename: Lynne R
authors.initials: LR
authors.lastname: Ferrari
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Borer
authors.forename: Craig A
authors.initials: CA
authors.lastname: Peters
mesh_terms: D000293:Adolescent; D002102:Cadaver; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007830:Larynx / Q000002:abnormalities / Q000601:surgery*; D008297:Male; D012371:Robotics / Q000295:instrumentation / Q000379:methods*