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Improved transoral dissection of the tongue base with a next-generation robotic surgical system
Michelle M Chen1, Ryan K Orosco1, Gil Chai Lim1,2
1Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University, Palo Alto, California, U.S.A.
Objectives/Hypothesis:
To describe the application of a novel, flexible, single-port robotic surgical system for transoral tongue base resection, and compare it to the current multiport, rigid-arm robotic surgical system.
Study Design:
Preclinical anatomic study using four human cadavers.
Methods:
Transoral resection of the tongue base using the da Vinci Sp and the Si robotic surgical systems. A standardized operative procedure is outlined, and operative parameters were compared between robotic systems.
Results:
Successful completion of tongue base resection was achieved in all cadavers using both the Sp and the Si systems. The optimal entry guide and instrument position for the Sp system was with the cannula rotated 180° from the standard position so that the camera was in the most inferior (caudal) channel. In the optimal configuration, no instrument exchanges were needed with the Sp system, but use of the Si system required one instrument exchange.
Conclusions:
This is the first preclinical anatomic study of robotic tongue base resection that compares a novel single-port robotic system to the current multiarm system. Surgical workflow was more streamlined with the da Vinci Sp system, and the new capabilities of simultaneous dissection, traction, and counter traction allowed for improved dissection and vessel control.
Level Of Evidence:
NA. Laryngoscope, 128:78-83, 2018.
