title: A transoral highly flexible robot: Novel technology and application.
abstract: OBJECTIVE
  Organ preservation surgery is a major focus in head and neck oncology. Current approaches are aimed toward improving quality of life and decreasing treatment-related morbidity. Transoral robotic surgery was developed to overcome the limitations of traditional surgical approaches. The most widely used robotic system is the da Vinci Surgical System. Although the da Vinci offers clear surgical advantages over traditional approaches, its rigid operative arms prevent complex maneuverability in three-dimensional space. The ideal surgical robot would configure to the anatomy of the patient and maneuver in narrow spaces. We present the first cadaveric trials of the use of a highly flexible robot able to traverse the nonlinear upper aerodigestive tract and gain physical and visual access to important anatomical landmarks without laryngeal suspension.
  
  
  METHODS
  Feasibility.
  
  
  METHODS
  Using human cadavers, we investigated the feasibility of visualizing the endolarynx transorally with a highly flexible robot without performing suspension of the larynx. Two fresh and four preserved human specimens were used.
  
  
  RESULTS
  Unhampered visualization of the endolarynx was achieved in all specimens without performing laryngeal suspension. Standard mouth retractors facilitated the delivery of the robot into the endolarynx.
  
  
  CONCLUSIONS
  The flexible robot technology mitigates laryngeal suspension and the limitations of current robotic surgery with rigid line-of-sight-directed instruments. Having demonstrated the feasibility of physical and visual access to the endolarynx, future work will study the feasibility of using the highly flexible robot in transoral robotic procedures with flexible instrumentation placed in the robot's available working ports.
authors.affiliation: Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Carlos M
authors.initials: CM
authors.lastname: Rivera-Serrano
authors.forename: Paul
authors.initials: P
authors.lastname: Johnson
authors.forename: Brett
authors.initials: B
authors.lastname: Zubiate
authors.forename: Richard
authors.initials: R
authors.lastname: Kuenzler
authors.forename: Howie
authors.initials: H
authors.lastname: Choset
authors.forename: Marco
authors.initials: M
authors.lastname: Zenati
authors.forename: Stephen
authors.initials: S
authors.lastname: Tully
authors.forename: Umamaheswar
authors.initials: U
authors.lastname: Duvvuri
mesh_terms: D000328:Adult; D002102:Cadaver; D004867:Equipment Design; D005240:Feasibility Studies; D006801:Humans; D007830:Larynx / Q000601:surgery*; D008866:Microsurgery / Q000295:instrumentation; D009055:Mouth; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D012371:Robotics / Q000295:instrumentation*