title: Robotic microlaryngeal surgery: feasibility using a newly designed retractor and instrumentation.
abstract: OBJECTIVE
  Robotic surgery is increasingly used for a variety of head and neck surgical procedures but has yet to be adapted for routine robotic microlaryngeal surgery (RMLS). Current retractor technology is limited by the following: poor tongue retraction, poor oral commissure retraction, poor larynx visualization, and laryngeal blades that do not take advantage of the robot's ability to operate without line-of-site exposure. Additionally, adequate instrumentation for RMLS is lacking.
  
  
  METHODS
  Feasibility study.
  
  
  METHODS
  We performed a feasibility study of RMLS using a newly designed robotic retractor in a cadaver model with the goal of routinely exposing the glottis. Microlaryngeal instrumentation was also adapted for the da Vinci Surgical Robot effector arms.
  
  
  RESULTS
  RMLS surgery was successfully performed including microflap elevation, anterior commissure surgery, false cordectomy, true cordotomy/cordectomy, and arytenoidectomy. Photographic and video documentation was obtained demonstrating feasibility.
  
  
  CONCLUSIONS
  We present a newly designed laryngeal robotic retractor and novel microlaryngeal instrumentation in a cadaveric model. This allows for glottic and anterior commissure exposure, effector arm access to the glottis, and performance of delicate endolaryngeal procedures with the robot. The overall efficacy of our retractor will need to be examined in an in vivo human model.
  
  
  METHODS
  NA.
authors.affiliation: Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, U.S.A.
authors.forename: Ian J
authors.initials: IJ
authors.lastname: Lalich
authors.forename: Steven M
authors.initials: SM
authors.lastname: Olsen
authors.forename: Dale C
authors.initials: DC
authors.lastname: Ekbom
mesh_terms: D002102:Cadaver; D004867:Equipment Design; D005240:Feasibility Studies; D006801:Humans; D007818:Laryngeal Diseases / Q000601:surgery*; D007825:Laryngectomy / Q000379:methods*; D008866:Microsurgery / Q000295:instrumentation*; D012371:Robotics / Q000295:instrumentation*
keywords: Microlaryngeal surgery; da Vinci Surgical System; endoscopic; surgery; transoral robotic surgery