A flexible, single-arm robotic surgical system for transoral resection of the tonsil and lateral pharyngeal wall: Next-generation robotic head and neck surgery.
OBJECTIVE
To describe the application of a novel flexible robotic surgical system to transoral endoscopic head and neck surgery of the tonsillar fossa and lateral oropharyngeal wall.


METHODS
Preclinical anatomic study using three human cadavers.


METHODS
Transoral resection of the lateral oropharyngeal wall with mucosal and muscular resection of the tonsillar fossa.


RESULTS
This single-port flexible robotic system could be used to successfully perform transoral resection of this region. The optimal angle to dock the patient-side cart was at a 90-degree angle to the operating room table. The placement of the remote center of the robotic instrument arm was evaluated in three positions. When the cannula tip was placed at 10 to 15 cm, all instruments could be deployed past the first and second joggle joint settings, without collision or restriction of arm movement. Using this position and docking location, all four arms were deployed inside the oral cavity without collision or restriction of movement in all three cadavers. The Da Vinci SP (Intuitive Surgical, Inc., Sunnyvale, CA) provided sufficient access, reach, and visualization in order to complete a transoral lateral oropharyngectomy.


CONCLUSIONS
The first preclinical feasibility study of a novel, flexible, single-arm robotic surgical system is presented for its use in transoral endoscopic head and neck surgery.


METHODS
N/A.
Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University, Palo Alto, California, U.S.A.
F Christopher
FC
Holsinger
D002102:Cadaver; D004867:Equipment Design; D005240:Feasibility Studies; D006801:Humans; D009055:Mouth; D009960:Oropharynx / Q000601:surgery*; D014066:Palatine Tonsil / Q000601:surgery*; D065287:Robotic Surgical Procedures / Q000295:instrumentation*; D014584:User-Computer Interface
Transoral endoscopic head and neck surgery; oropharyngeal carcinoma; tonsil; transoral robotic surgery