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Identification and Protection of the Recurrent Laryngeal Nerve during Transoral Robotic Thyroidectomy
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Transoral Robotic Surgical Proficiency Via Real-Time Tactile Collision Awareness System.

Abie H Mendelsohn1,2, Christine Kim1, Jonathan Song2

  • 1Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, U.S.A.

The Laryngoscope
|September 1, 2020
PubMed
Summary

Anatomic collisions during transoral robotic surgery (TORS) negatively impact surgical performance. A new TORS training platform with tactile feedback reduced collisions and improved surgical proficiency, suggesting its utility in training surgeons.

Keywords:
TORShapticsrobotic surgerysurgical skilltraining

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Area of Science:

  • Robotic Surgery
  • Surgical Training
  • Otolaryngology-Head and Neck Surgery

Background:

  • Transoral robotic surgery (TORS) is increasingly adopted for upper aerodigestive tract conditions.
  • Technical limitations, particularly operating in confined spaces, lead to anatomic collisions.
  • Objective assessment and improvement of TORS skills remain challenging due to these limitations.

Purpose of the Study:

  • To develop and validate a TORS training platform with integrated anatomic collision sensing and real-time tactile feedback.
  • To test the hypothesis that anatomic collisions negatively impact TORS surgical performance.
  • To evaluate if reducing collisions through tactile feedback improves TORS proficiency.

Main Methods:

  • A custom TORS training platform with collision-sensing and tactile feedback was designed and tested.
  • Twenty otolaryngology residents performed mock surgical trials, with half using the real-time feedback system.
  • Surgical proficiency was assessed using Global Evaluative Assessment of Robotic Skills (GEARS) scores, completion time, and tumor resection adequacy.

Main Results:

  • Major anatomic collisions significantly decreased GEARS scores (0.29 points per collision, P = .04).
  • The tactile feedback system significantly reduced major collisions (2.9 vs. 12.53, P < .001).
  • Tumor resection scores were significantly improved with collision awareness (P = .02), while completion time was unaffected.

Conclusions:

  • Anatomic collisions during TORS diminish surgical performance.
  • A TORS training platform with real-time tactile feedback effectively reduces collisions and enhances surgical proficiency.
  • Further research is needed to integrate these findings into surgical training curricula and clinical practice.