Robotic Surgery in the Pediatric Airway

Abstract

To assess the application and safety of transoral robotic surgery in the pediatric airway.Design: An institutional review board-approved study. Experimental laryngeal surgery was performed on 4 pediatric cadaver larynxes as controls. Application of robotic equipment for laryngeal surgery was attempted on 5 patients.Setting: Tertiary care pediatric medical center.Patients: Five patients with laryngeal cleft and 4 pediatric cadaver larynxes.Interventions: (1) The da Vinci Surgical Robot (Intuitive Surgical Inc, Sunnyvale, Calif ) was used on 4 cadaver larynxes and assessed for the dexterity, precision, and depth perception that it allowed the surgeon during laryngeal surgery. Procedures were documented with still and video photography. (2) The da Vinci Surgical Robot was used through a transoral approach to attempt repair of a laryngeal cleft in 5 pediatric patients who were under spontaneously breathing general anesthesia.Results: (1) Use of the surgical robot on cadaver larynxes provided great dexterity and precision, delicate tissue handling, good 3-dimensional depth perception, and relatively easy endolaryngeal suturing. (2) The surgical robot could not be used for repair of laryngeal cleft on 3 patients owing to limited transoral access. However, 1 patient with a type 1 laryngeal cleft and 1 patient with a type 2 laryngeal cleft underwent transoral robotic repair with great success.Conclusions: Surgical robots provide the ability to manipulate instruments at their distal end with great precision, increased freedom of movement, and excellent 3-dimensional depth perception. The size of the equipment can be a limiting factor with regard to the application and success of the transoral approach to airway surgery. We believe that further advances in device technology and a new generation of robotic equipment will facilitate the incorporation of surgical robotics in the advancement of minimally invasive endoscopic airway surgery.

Transoral robotic surgery for the management of head and neck tumors: learning curve

“…It filters out natural hand tremor, adjusts the large hand movements of the operator to the small movements of instruments in the airway enhancing dexterity and finally it allows a three-dimensional visualization of the surgical field which gives the surgeon true depth perception [4]. Taking advantage of these characteristics, many surgeons are performing transorally, surgeries that were still performed with an open approach, such as resection base of tongue of cancer, or supraglottic laryngectomies, or resection of hypopharyngeal tumors [5,[8][9][10][11].…”

“…Robotic surgery has the potential to address the shortcomings of TLM; however, it was introduced in the field of otolaryngology a decade after its use in laparoscopic, thoracoscopic, cardiac, and urologic surgical procedures [4].…”

Transoral Robotic-Assisted Lingual Tonsillectomy in the Pediatric Population

“…In 2007, Rahbar et al 7 attempted laryngeal cleft repair in 5 children, but 3 cases could not be completed because of limitation of visualization and insufficient space to maneuver instruments. While our population of patients consisted of children undergoing lingual tonsillectomy rather than laryngeal cleft repair, each case attempted was successfully completed.…”

“…The 3-dimensional endoscopic view, 12 freedom of motion of microinstruments, and filtering of tremor are wellestablished advantages of robotic surgery for head and neck cases. 7,[12][13][14] With respect to performing lingual tonsillectomy, the surgical robot allows the creation of a clean dissection plane, which provides unmatched exposure of the tongue base musculature. In addition, the 3-dimensional endoscopic view affords magnification of the working area, allowing visualization of fine structures, including the glossopharyngeal nerve, that are difficult to identify otherwise ( Figure 6).…”

Combining a new CO2 laser wave guide with transoral robotic surgery: a feasibility study on four patients with malignant tumors

“…In the era of organ preservation surgery, transoral robotic surgery (TORS) is used by an increasing number of head and neck surgeons for the treatment of pharyngo-laryngeal tumors [1][2][3][4]. The Da Vinci surgical system (Intuitive Surgical Inc, Sunnyvale, CA, USA) is mostly used in the oropharynx, supraglottis and piriform sinus for the treatment of malignant and sometimes benign tumors [5][6][7][8][9].…”