title: Infant Robotic Cleft Palate Surgery: A Feasibility Assessment Using a Realistic Cleft Palate Simulator.
abstract: BACKGROUND
  A surgical robot offers enhanced precision, visualization, and access and the potential to improve outcomes in cleft palate surgery. The goal of this study was to investigate the feasibility of using the da Vinci robot for cleft palate repair in infants using a cleft palate simulator test bed.
  
  
  METHODS
  A high-fidelity cleft palate simulator was developed that allows performance of a robotic cleft palate repair procedure. A complete cleft palate repair was performed with the da Vinci Si with 5-mm instruments and the da Vinci Xi with 8-mm instruments. The advantages of the robotic approach were assessed in comparison with using standard instruments. For each system, arm repositioning, collisions, instrument and endoscope excursion, wrist orientation, and vision were compared for 12 steps of the repair.
  
  
  RESULTS
  The cleft palate simulator provided a reproducible platform for testing robotic cleft palate surgery. The advantages of the robotic approach were the ability to articulate a miniature wrist intraorally with superior visualization, increased ambidexterity, and improved ergonomics compared with using standard instruments. Cleft palate repair with the Xi was superior to the Si with respect to arm repositioning, instrument collisions and excursion, and wrist orientation. However, Xi performance remained suboptimal because of the larger instruments.
  
  
  CONCLUSIONS
  Robotic cleft palate repair using the da Vinci system offers advantages compared with the traditional approach. Cleft palate repair is more feasible with the Xi and 8-mm instruments. However, performance is limited by the instrumentation, which requires modification to ensure safety and efficacy.
  
  
  METHODS
  Therapeutic, V.
authors.affiliation: Toronto, Ontario, Canada.|From the Division of Plastic and Reconstructive Surgery, University of Toronto; the Center for Image-Guided Innovation and Therapeutic Intervention; and the Divisions of Plastic and Reconstructive Surgery and Neurosurgery, The Hospital for Sick Children.
authors.forename: Dale J
authors.initials: DJ
authors.lastname: Podolsky
authors.affiliation: Toronto, Ontario, Canada.|From the Division of Plastic and Reconstructive Surgery, University of Toronto; the Center for Image-Guided Innovation and Therapeutic Intervention; and the Divisions of Plastic and Reconstructive Surgery and Neurosurgery, The Hospital for Sick Children.
authors.forename: David M
authors.initials: DM
authors.lastname: Fisher
authors.affiliation: Toronto, Ontario, Canada.|From the Division of Plastic and Reconstructive Surgery, University of Toronto; the Center for Image-Guided Innovation and Therapeutic Intervention; and the Divisions of Plastic and Reconstructive Surgery and Neurosurgery, The Hospital for Sick Children.
authors.forename: Karen W Y
authors.initials: KWY
authors.lastname: Wong Riff
authors.affiliation: Toronto, Ontario, Canada.|From the Division of Plastic and Reconstructive Surgery, University of Toronto; the Center for Image-Guided Innovation and Therapeutic Intervention; and the Divisions of Plastic and Reconstructive Surgery and Neurosurgery, The Hospital for Sick Children.
authors.forename: Thomas
authors.initials: T
authors.lastname: Looi
authors.affiliation: Toronto, Ontario, Canada.|From the Division of Plastic and Reconstructive Surgery, University of Toronto; the Center for Image-Guided Innovation and Therapeutic Intervention; and the Divisions of Plastic and Reconstructive Surgery and Neurosurgery, The Hospital for Sick Children.
authors.forename: James M
authors.initials: JM
authors.lastname: Drake
authors.affiliation: Toronto, Ontario, Canada.|From the Division of Plastic and Reconstructive Surgery, University of Toronto; the Center for Image-Guided Innovation and Therapeutic Intervention; and the Divisions of Plastic and Reconstructive Surgery and Neurosurgery, The Hospital for Sick Children.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Forrest
mesh_terms: D002972:Cleft Palate / Q000601:surgery*; D004867:Equipment Design; D005240:Feasibility Studies; D006801:Humans; D007223:Infant; D019651:Plastic Surgery Procedures / Q000295:instrumentation / Q000379:methods*; D065287:Robotic Surgical Procedures / Q000295:instrumentation; D000066908:Simulation Training