Training for Robotic-Assisted Surgery
The first workshop and formal educational program in robotics for head and neck was taught by Drs. Weinstein and O’Malley at the Intuitive Surgery Training Facility in California. That course included a core group of 12 head and neck surgeons from several institutions, including the Mayo Clinic, M. D. Anderson Cancer Center, and Mount. Sinai Medical Center. These individuals, including Dr. Holsinger, have now gone back to their respective institutions to initiate IRB-approved studies of TORS. Drs. Weinstein and O’Malley are conducting an IRB-approved study at the University of Pennsylvania that is still open. Thus far, 120 patients have entered the trial, and only two of them had anatomy that was inaccessible for a robotic-assisted procedure.
If TORS gains FDA approval based on these studies, the University of Pennsylvania will offer a training course in robotics procedures. The plan is to have a two-day course, with one day in the laboratory and another day of observation. Other institutions will undoubtedly offer courses in robotics as well, said Dr. Weinstein.
The University of Pennsylvania also plans to erect a special building for research and training in robotics, Dr. O’Malley said. We hope that the people we trained [at the first training session last year] will set up their own programs and spread the seed-establishing more research and developing new procedures and applications, he added.
The Future of Robotics
In the future, it would be ideal to have smaller instruments to allow deeper access beyond presently defined boundaries, Dr. Weinstein said. Smaller instruments will be developed to allow access to the nasal cavity as an alternative to endoscopic surgery.
While the first TORS skull base surgery cases have been reported from the University of Pennsylvania, further miniaturization of instruments and more flexible instruments, tactile feedback, and techniques for skull based procedures will probably be developed, Dr. O’Malley said. At M. D. Anderson, transoral approaches through the nose to the skull base are being studied in the cadaver model using robotic-assisted techniques. If skull base procedures can be done with robotics, surgery could carry much less morbidity.
Another pressing need, according to Dr. O’Malley, is two-handed, delicate, fine magnification procedures for the vocal cords or subglottis, which may also be applicable to skull base surgery. The technology is not there yet, but it should be in the next five or 10 years. The team at the University of Pennsylvania is studying robotic-assisted surgery for skull-based procedures. There is a need to refine and hone instruments for these procedures, Dr. O’Malley continued.
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