Robotic Head and Neck Surgery: History, Technical Evolution and the Future

Garas, George; Arora, Asit

doi:10.1159/000489464

Cited by 33 publications

(30 citation statements)

References 32 publications

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“…Robotic surgery was first used in 1985 (11). The first application of robotic surgery in head and neck cancer occurred 20 years later in 2005 when McLeod and Melder used the da Vinci robot to resect a vallecular cyst (12).…”

Section: Methodsmentioning

confidence: 99%

“…That same study concluded that TORS is currently underutilized due to the associated expenses (59), particularly in countries with limited resources such as Estonia, Latvia, and Lithuania where TORS is currently unavailable. Although cost is currently an important barrier to the wider uptake of robotic surgery, the impending commercialization of new, smaller, more flexible surgical robots is likely to decrease costs, and expand current indications for TORS (11).…”

Section: Methodsmentioning

confidence: 99%

“…Despite the predominance of the da Vinci robotic systems, several novel, flexible surgical robots are currently in development and the commercial introduction of these robots is expected to decrease costs and expand current indications for TORS, thus enabling wider adoption of this technology (11). These tools include new miniaturized, flexible robots, such as the i-Snake® (Imperial College London, London, UK) (63), and Flex® systems (Medrobotics®, Raynham, MA, USA), which are better-suited than the da Vinci robot for head and neck surgery (11). Other companies are also investing in the design and manufacture of new surgical robots, and this new competition is likely to lead to lower costs, making robotic surgery less expensive while, at the same time, increasing the number of indications in locations with difficult access with current technology.…”

Section: Methodsmentioning

confidence: 99%

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Functional Organ Preservation Surgery in Head and Neck Cancer: Transoral Robotic Surgery and Beyond

Golusiński

2019

Front. Oncol.

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In recent years, interest in functional organ preservation surgery (FOPS) in the treatment of head and neck cancer has increased dramatically as clinicians seek to minimize the adverse effects of treatment while maximizing survival and quality of life. In this context, the use of transoral robotic surgery (TORS) is becoming increasingly common. TORS is a relatively new and rapidly-evolving technique, with a growing range of treatment indications. A wide range of novel, flexible surgical robots are now in development and their commercialization is expected to significantly expand the current indications for TORS. In the present review, we discuss the current and future role of this organ-preserving modality as the central element in the multimodal treatment of head and neck cancer.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Functional Organ Preservation Surgery in Head and Neck Cancer: Transoral Robotic Surgery and Beyond

Golusiński

2019

Front. Oncol.

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“…We believe that with updates of CT and MRI equipment, thinner layers and newer pixel technologies will continue to emerge, and image-mediated clinical surgery will be more accurate and have a greater clinical value. Just as Garas and Arora [15] said, future directions relate to overlay technology through augmented reality that allows real-time image guidance.…”

Section: Discussionmentioning

confidence: 99%

Extension of the Clinical Significance of the “Cog”

Wang

Jiang²,

Zhang

et al. 2018

ORL

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Objective: To study the clinical anatomy of the epitympanum, the attic, and its medial wall, to try to discover a new clinical operation-related anatomical landmark, and to investigate the adjacent anatomical relationship with this landmark. Materials and Methods: Eight donor temporal bone specimens were dissected endoscopically. For 29 healthy persons (17 males and 12 females), CT images of the temporal bone (57 ears) were taken, 3-dimensional (3-D) reconstruction and multidimensional plane reconstruction were performed, and identification and assessment of 3-D spatial relationships between any 2 of these complex structures were done. Results: 3-D images of the temporal bone structures including the facial nerve, the cochlea, the semicircular canal, and the brain plate were reconstructed and shown in detail. We discovered a new clinical surgery-related anatomical landmark (the “cog” tangent and the trailing edge of the cog). Based on the tangent and the trailing edge of the cog, we quantified the anatomical relationship between it and its neighboring important structures. Conclusion: Based on endoscopic anatomy and the temporal bone spiral CT 3-D structure reconstruction of the epitympanum, the attic, and the adjacent structures, we found an extension of the clinical significance the cog. Quantification of the adjacent anatomical relationship of this landmark is very important for otology microsurgical operation.

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“…TORS using the da Vinci also provides the surgeon with a three-dimensional view and endo-wristed instruments with seven degrees of freedom, thereby ameliorating surgical dexterity. 7 In contrast to trans-oral LASER microsurgery (TLM), where line-of-sight can be a significant issue, tumors can be resected en-bloc using TORS, maintaining the essential surgical oncology principle not to remove the tumor piecemeal. This also permits better histopathological assessment of the tumor; of great importance when considering treatment de-escalation.…”

Section: A Brief History Of Robotic Surgery In Entmentioning

confidence: 99%

<p>Novel Energy Devices in Head and Neck Robotic Surgery – A Narrative Review</p>

Ross¹,

Tolley²,

Awad³

2020

RSRR

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The advent of trans-oral robotic surgery (TORS) has facilitated removal of tumors previously deemed unresectable, by providing access to the deep structures of the head and neck. Despite this, the wider dissemination of TORS has been restricted due to issues with line of access, as the da Vinci robot was never designed with head and neck surgery in mind. Flexible instruments and novel energy delivery devices offer great potential in overcoming some of the existing challenges surrounding TORS. This review aimed to summarize the existing literature surrounding energy delivery in TORS and highlight areas of future innovation. MEDLINE was searched for studies relating to energy delivery in TORS in November 2019. The existing literature surrounding monopolar and bipolar electrocautery, LASER (CO 2 , Tm:YAG and blue LASER), Ligasure and Harmonic was reviewed. Additionally, the latest iteration of the da Vinci; the SP, and the FLEX robot were evaluated as novel methods of energy delivery in TORS. Overall, these novel energy devices and robotic systems are predicted to further improve energy delivery to the head and neck. The use of flexible LASER in particular is well substantiated in the literature. This has the potential to achieve treatment de-escalation, based on the excellent outcomes demonstrated for disease-free margins and post-operative morbidity.

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Robotic Head and Neck Surgery: History, Technical Evolution and the Future

Cited by 33 publications

References 32 publications

Functional Organ Preservation Surgery in Head and Neck Cancer: Transoral Robotic Surgery and Beyond

Functional Organ Preservation Surgery in Head and Neck Cancer: Transoral Robotic Surgery and Beyond

Extension of the Clinical Significance of the “Cog”

<p>Novel Energy Devices in Head and Neck Robotic Surgery – A Narrative Review</p>

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