How does a novel, flexible, single-port robotic surgical system for transoral tongue base resection compare to the current multiport, rigid-arm robotic surgical 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.
Background: Currently, transoral robotic surgery, designed for cardiac and abdomino-pelvic surgery, is the only commercially available robotic surgical system for multidisciplinary treatment for oropharyngeal squamous cell carcinoma. The da Vinci Si surgical robot’s dimensions are larger than what would be ideal for head and neck surgery, and it utilizes three rigid instrument arms that must approach transoral anatomy from a sometimes troublesome trajectory outside of the surgical field. The newer da Vinci Sp provides three fully articulating instruments delivered through a single 25-mm cannula entry port.
Study design: Preclinical anatomic study of four human cadavers using the da Vinci Si and the da Vinci Sp surgical robots.
Setting: Intuitive Surgical, Sunnyvale, Calif.
Synopsis: Successful completion of transoral resection of the tongue base was achieved in all four cadavers using both systems. Three cadavers were dentate and one was edentulous; no dental injury occurred in the three dentate cadavers, nor were there lip or facial abrasions. The default camera position (above) was utilized for the first Sp tongue base resection, but this configuration contributed to significant difficulty in visualization and dissection, resulting in a prolonged operative time of 23.25 minutes.
For the next three Sp procedures, a more optimal configuration was utilized (operative time 6.22 to 8.85 minutes). For each procedure with the Si system, one instrument exchange occurred to facilitate better soft tissue handling as the specimen became larger and more difficult to grasp. Three-instrument operating with the Sp improved the ability to provide traction and counter traction on the soft tissues of the tongue base.
Citation: Chen MM, Orosco RK, Lim GC, Holsinger FC. Improved transoral dissection of the tongue base with a next-generation robotic surgical system. Laryngoscope. 2018;128:78–83.