Robotics for Head and Neck Surgery: The Wave of the Future?

We can avoid tracheostomy, complex skin reconstruction, and jaw splitting with robotics, using one three-hour procedure and then a second procedure for another three hours to take out lymph nodes, Dr. Weinstein said.

Robotics causes less injury to speech and swallowing structures, and less cosmetic damage, because it is less invasive than open surgery. Also, robotics shortens surgical times from six to 18 hours to two hours. Robotics also allows good control of bleeding, Dr. O’Malley added. With robotics, we can use both hands for surgical procedures, whereas endoscopic-based procedures are typically done with one hand, because the other hand holds the endoscope.

For other lesions, such as lesions in the supraglottis or larynx, the major advantages of robotics over open surgery are better access and faster surgical times.

Robotics offers a three-dimensional visual environment that puts the surgeon right where the surgery is happening. This unique perspective allows the surgeon to operate at the same level as the anatomy of interest. ‘Master’ control manipulators then allow the surgeon to use precise instruments in situations and in ways that were never before possible. For instance, the surgeon can rotate a given instrument 540 degrees and overcome the limitations of the human wrist, said Dr. Holsinger.

Limitations of Robotic-Assisted Surgery

One limitation of robotic-assisted surgery, with present techniques, is limited access. Some tumors are located too deep in the laryngopharynx to allow access, Dr. Weinstein said. With current technology, it is difficult to have greater access beyond present boundaries (i.e., tumors not lower than the vocal cords and not higher than the lower nasopharynx), Dr. O’Malley commented.

Also, at present there are no robotic instruments for drilling and removing bone. ENTs use a lot of drills, and it is expected that companies will be developing rongeurs and drills along with the software to drive these tools using the robot, Dr. O’Malley said.

It would also be desirable to have haptic or tactile feedback with robotics, such as is used by the military. At present, we have to rely on the tremendous three-dimensional visualization for feedback. As we take the surgical robot into new frontiers, such as skull-based surgery, it would be advantageous to have a system for tactile feedback, Dr. O’Malley said.

According to Dr. Holsinger, at present the CO2 laser is used with endoscopy to resect tumors and develop planes, but this has limitations. The ideal technique would combine the precise tissue handling properties of the CO2 laser with robotics. Research efforts are aimed at trying to find an optimal laser to combine with robotics, he said.