title: Trans-oral robotic cleft surgery (TORCS) for palate and posterior pharyngeal wall reconstruction: A feasibility study.
abstract: OBJECTIVE
  Robot-assisted surgery has become increasingly routine, replacing open and laparoscopic techniques in certain domains, with recent extension to head and neck surgery through trans-oral access. Some advantages of the robot-assisted surgery include the ability to access confined spaces, enhanced dexterity instrumentation with intuitive movement, motion scaling, tremor elimination and three-dimensional (3D) endoscopic viewing with true depth perception. The aim of this study was to investigate the technical feasibility of trans-oral robotic cleft surgery (TORCS) to access the posterior pharyngeal wall and palate for potential use in the cleft population.
  
  
  METHODS
  All possible permutations of patient and robotic instrument configurations were used with the daVinci Si Surgical System® (Intuitive Surgical, USA) 0° and 30° 3D endoscopes and 8-mm training instruments to determine the optimal visualization and surgical access to the palate and posterior pharynx in a paediatric airway manikin, and to simulate posterior pharyngeal wall surgery. A full robot-assisted cadaveric Hynes pharyngoplasty was performed using 5-mm training instruments. Experiments were recorded with still and video photography.
  
  
  RESULTS
  TORCS is technically feasible in the paediatric cleft population. We predict a short learning curve due to the intuitive instrumentation, easier dissection and the potential to limit secondary insult compared with traditional surgery, as well as improved ergonomics for the operating surgeon.
  
  
  CONCLUSIONS
  The as-yet unreported use of robotic-assisted cleft palate surgery may considerably enhance a surgeon's ability to perform difficult procedures of the palate and posterior pharynx in selected patients with limited access as well as lay the foundation for potential novel techniques.
authors.affiliation: Spires Cleft Centre, Oxford University Hospitals NHS Trust, Oxford, UK. Electronic address: drkkhan@gmail.com.
authors.forename: Khurram
authors.initials: K
authors.lastname: Khan
authors.affiliation: Spires Cleft Centre, Oxford University Hospitals NHS Trust, Oxford, UK.
authors.forename: Tom
authors.initials: T
authors.lastname: Dobbs
authors.affiliation: Spires Cleft Centre, Oxford University Hospitals NHS Trust, Oxford, UK.
authors.forename: Marc C
authors.initials: MC
authors.lastname: Swan
authors.affiliation: Department of Otolaryngology: Head and Neck Surgery, Hospital of the University of Pennsylvania, PA, USA.
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Weinstein
authors.affiliation: Spires Cleft Centre, Oxford University Hospitals NHS Trust, Oxford, UK.
authors.forename: Tim E E
authors.initials: TE
authors.lastname: Goodacre
mesh_terms: D002102:Cadaver; D002648:Child; D002972:Cleft Palate / Q000601:surgery*; D005240:Feasibility Studies; D006801:Humans; D008348:Manikins; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D019647:Oral Surgical Procedures / Q000379:methods*; D010614:Pharynx / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012371:Robotics / Q000379:methods*
keywords: Cleft; Pharyngeal; Robot-assisted; daVinci Surgical System(®)