This document discusses the history and applications of robotics in ENT surgery. It begins with definitions of medical robots and an overview of their history. It then focuses on specific ENT applications including:
1) TORS (Transoral Robotic Surgery) for tumors of the tongue base, tonsils, and throat which offers improved visualization and dexterity.
2) Robotic surgery for obstructive sleep apnea by allowing minimally invasive resection of excess tongue base tissue.
3) Robotic thyroidectomy techniques like RATS (Robotic Assisted Thyroidectomy) and robotic facelift thyroidectomy which allow smaller incisions.
4) Potential future applications in rhin
Transoral robotic surgery(TORS)has emerged as a technique thatallows head and neck surgeons to safely resect large and complex oropharyngeal tumors without dividing the mandible or performing a lip-split incision. These resections provide a reconstructive challenge because the cylinder of the oropharynx remains closed and both physical access and visualization of oropharyngeal anatomy is severely restricted. Transoral robotic reconstruction (TORRS) of such defects allows the reconstructive surgeon to inset freeflaps or perform adjacent tissue transfer while seeing what the resecting surgeon sees. Early experience with this technique has proved feasible and effective. Robotic reconstruction has many distinct advantages over conventional surgery,and offers patients a less morbid surgical course. Robotic-assisted head and neck cancer surgery is an alternative approach for the management of oropharyngeal tumors, but necessitates the development of appropriate reconstructive methods. TORR represents a bourgeoning robotic transoral reconstructive technique and may eventually be a critical part of any robust TORS program rational approach to the use of the robot in transoral reconstruction will help guide the development of this field.
Transoral robotic surgery(TORS)has emerged as a technique thatallows head and neck surgeons to safely resect large and complex oropharyngeal tumors without dividing the mandible or performing a lip-split incision. These resections provide a reconstructive challenge because the cylinder of the oropharynx remains closed and both physical access and visualization of oropharyngeal anatomy is severely restricted. Transoral robotic reconstruction (TORRS) of such defects allows the reconstructive surgeon to inset freeflaps or perform adjacent tissue transfer while seeing what the resecting surgeon sees. Early experience with this technique has proved feasible and effective. Robotic reconstruction has many distinct advantages over conventional surgery,and offers patients a less morbid surgical course. Robotic-assisted head and neck cancer surgery is an alternative approach for the management of oropharyngeal tumors, but necessitates the development of appropriate reconstructive methods. TORR represents a bourgeoning robotic transoral reconstructive technique and may eventually be a critical part of any robust TORS program rational approach to the use of the robot in transoral reconstruction will help guide the development of this field.
Videonystagmography is also known as VNG, is a most advanced diagnostic test for a balance disorder. Individuals who feel dizzy and face difficulty in maintaining their balance and equilibrium should undergo the videonystagmography diagnostic test.
Sinus tymapni shape and depth can influence surgical approach in cholesteatoma surgery. In the case of a shallower ST, an exclusive endoscopic exploration is chosen; while in the case of a deeper ST, a retrofacial approach is usually preferred.
Cavity obliteration is a procedure done at the end of Mastoidectomy to get a cavity-less mastoid cavity thus solving the problem of discharging post-operative cavity.
This is a presentation I used for my seminar on 'Phonosurgery' on 4th November, 2015. I hope they are useful to you. Constructive as well as Destructive criticism welcomed.
Videonystagmography is also known as VNG, is a most advanced diagnostic test for a balance disorder. Individuals who feel dizzy and face difficulty in maintaining their balance and equilibrium should undergo the videonystagmography diagnostic test.
Sinus tymapni shape and depth can influence surgical approach in cholesteatoma surgery. In the case of a shallower ST, an exclusive endoscopic exploration is chosen; while in the case of a deeper ST, a retrofacial approach is usually preferred.
Cavity obliteration is a procedure done at the end of Mastoidectomy to get a cavity-less mastoid cavity thus solving the problem of discharging post-operative cavity.
This is a presentation I used for my seminar on 'Phonosurgery' on 4th November, 2015. I hope they are useful to you. Constructive as well as Destructive criticism welcomed.
We live in an age of a new unpreceded wonders. The wonders of the world are not seven any more. The inanimate talk to us. We are flying in the air. More than 65,000-Ton can float over the water in an iron vessel. The Robotic Doctor is already a reality. Reviewing the history of mankind's cumulative experience starting with the ancient very primitive trials and ending with the presence of Robotic and Telesurgery
Clearly show that the major and rapid advances in the whole mankind's life occur only in the last few decades especially the last 10 years ? .
This brief presentation highlights the major applications of surgical robots in addition to the most used models. It also briefs the current benefits and limitations of this technology.
Robotic surgery :-
Definition
limitations
History
Types
Applications
Advantages and disadvantages
Reference
,robotic surgery ,applications of robotic surgery ,advantages of robotic surgery ,disadvantages of robotic surgery ,uses of robotic surgery ,cardiac surgery ,gynecology ,neurosurgery ,radio surgery ,shared control robotic surgery ,da vinci robotic surgical system ,tele surgery system ,types of robotic surgery ,history of robotic surgery
Anaesthetic considerations for Robotic Surgery, What to expect, how to go ahead. An update and incite on the intricacies of Robotic Surgery and Anaesthetic implications.
Significant improvements in the surgical approaches and management of diseases have been made in the last century since the advent of antibiotics and aseptic surgical techniques. A major revolution has happened in the last 25 years, as the focus has shifted to minimally invasive surgery and subsequently to robotic assisted surgery. The da Vinci system is by far the most successful surgical robot in use today.
Anatomy of Skul base and Infratempoal fossaAVINAV GUPTA
This presentation briefly discusses the anatomy of skull base and infratemporal fossa. It describes the anatomical boundaries and relations of Skull base and infratemporal fossa.
This presentation comprises of various chemotherapeutic agents used in ENT malignancies and other conditions. Its classifies the agents and briefly discusses the dosage and their common side effects.
This presentation is about the benign lesions of Larynx in ENT. Their classification, definition, clinical features, relevant investigations and management.
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Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
2. Definition
Robotic surgery implies the use of
power device that functions under
Programmable computerized control
and may be used to manipulate
instruments and to perform surgical
task
3. History of Medical Robots
• 1985 PUMA 560 > Steriotactic brain
biopsy
• 1988 PORBOT > transuretheral
resection of prostate
• 1992 ROBODOC > total hip
arthroplasty
• 1995 da Vinci Surgical System
• 1998 ZEUS > gastrointestinal,
cardiac and urological cases
4. 2002, Terris and Haus -> explored endoscopic neck procedures.
1st human application McLeod and Melder (2005) - excision of a
vallecular cyst with the robot.
5. • Weinstein et al. described the new procedure TORS radical
tonsillectomy in their first series of 27 patients with tonsillar
squamous cell carcinoma.
• TORS allows excellent access for resection of carcinoma of the tonsil
Intraoperative photos of TORS radical tonsillectomy for T1 squamous cell carcinoma of the tonsil.
(A) Tumor arising from the
right tonsil;
(B) Dissection in the
parapharyngeal space fat;
(C) Postoperative defect left to
heal by secondary intention
6. ACCORDING TO THE ROLE-BASED CLASSIFICATION
1. Active Robot
2. Semi active Robot
3. Passive Robot
CLASSIFICATION OF ROBOTIC SURGICAL SYSTEMS
1. Supervisory-controlled systems
2. Telesurgical system
3. Shared-control system
7. SUPERVISORY-CONTROLLEDSYSTEM
• Most automated type
• System follows a specific set of instructions.
• Surgeon input data into robot.
Three step process:
a. Planning- Determine the surgical pathway
b. Registration- Surgeon finds the points on the patient body
c. Navigation- Surgeon activates the robot
8. TELESURGICAL SYSTEMS
• Surgeon direct the motion of
the robot.
3 main types-
• Da Vinci Surgical System
• ZEUS robotic Surgical System
• AESOP robotic Surgical System
9. SHARED-CONTROL SYSTEM
• Shared-control robotic systems aid
surgeons during surgery, but the human
does most of the work -> Active
constraint
• The robotic system monitors the
surgeon's performance and provides
stability and support
10.
11. Specific surgical robotic system
• AESOP(Automated system
optimal positioning)
• Released 1994
• First robot clearance
• Single surgical arm for voice-
activated camera positioning
12. • Neuromate (Integrated
surgical systems)
• Neurosurgical robots used
to place probes, electrodes
and drills under stereotactic
guidance into the brain
13. • The ZEUS Surgical System(computer motion, CA) is made up of an
ergonomic surgeon control console and three table-mounted robotic
arms, which perform surgical tasks and provide visualization during
endoscopic surgery.
• Voice activated.
14. • Da Vinci Surgical System(Intuitive Surgical, CA) is currently
the most widely used surgical robot.
15. INITIAL ROBOTIC APPLICATIONS IN
OTOLARYNGOLOGY
• The da Vinci robot is currently the
only widely available surgical
robotic system in use.
• It has four components:
-Surgeon console
- Vision system
- Endowrist instruments
- Patient side cart with four robotic
arms
Operating room setup for TORS
16. • To operate The Da Vinci
surgical system
• Surgeon sits at a console
viewing a high definition 3D
image inside the patient's
body
• The console is fitted with a
glove like Apparatus that
translates the surgeon's hand
and finger movements into
real time movements of the
surgical instruments
Operating room setup for TORS
17. • Patient side cart -
next to the patient -
four robotic arm
• One arm holding the
camera
• The Other arms
holding the
instruments
18. • Dual mounted endoscope provide distinct views to the right and left
eyes - 3D vision to the surgeon at the console
• 0 degree & 30 degree , 12mm or 8mm dia
19. Range of instruments mounted to the robotic arm can be used to
perform any surgical manoeuvre:
• Clamping
• cutting
• suturing
• ligating
• tissue dissection
20. Each instrument has seven degrees of
freedom
• 3 translational (up and down, left and right,
forward and backward)
• Three rotational (roll, yaw and pitch)
• One grip (cutting, grasping etc)
• The tip of each instrument allows 90
degree of articulation
21. ZEUS
• Position of bed can be
altered, all robot arm
remain in constant location
• 3arms
• Voice controlled camera
• 5 degree of freedom
• Surgeons console- open
DA VINCI
• Once the robot arms are
docked, bed position
cannot be manipulated
• 4arms
• No voice activation
• 7 degree of freedom
• Surgeons console-
closed
22. Additional benefit of The da Vinci surgical system
• Motion scaling and tremor reduction
• Passive Robotic Technology
(robotic arms replicate precisely -movement of the surgeon's hands)
23. Advantages of robotic surgery over
traditional laparoscopic surgery
• Improved 3D visualisation
• Greater accuracy
• Improved dexterity with wristed
instruments
• Better ergonomic for the surgeon
24. Advantages of robotic surgery
• Tremor control and motion scaling
• Image guidance and stereotactic
orientation
• Binocular endoscopic vision
• Telepresence and telemonitoring
• Other factors
25. Disadvantages
• Expenses
• Size- instrument size is not small
• Loss of force feedback/haptics-
• Spacious OR
• Training and learning curve
• Question of saftey
26. Clinical application
• Tongue base tumors
• OSA
• Tonsils- SCC
• OPSCC
• Thyroid surgeries
• Parotid surgeries
• Otology
• Skull base
27. RESECT TONGUE TUMOURS
1. Binocular magnification
-Clearer visualization of tumor
boundries
-Vascular tissue
-Aids accurate assessment of
tumour margins.
Suture through tongue and tooth guard in place
28. 2. ‘Wristed’ 3D mobile
grasping and cutting
instruments
3. ‘Robotic surgeon’ - grasp,
cut, ligate and suction in the
field simultaneously.
Dingman retractor setup with
suction tongue blade
29. TORS view of base of tongue squamous cell carcinoma. 1. Base of tongue; 2.
Base of tongue SCC; 3. 5-mm Maryland dissection forceps; 4. Left Tonsillar
fossa; 5. Uvula. 6. 5-mm monopolar cautery.
30. OBSTRUCTIVE SLEEP APNEA
• Tongue base hypertrophy- morbidity associated with open surgery
• TORS
• minimally invasive
• Improved efficacy
• minimal morbidity
31.
32. (a) is the view following transoral
robotic en bloc resection of a T2
tonsil cancer.
(b) is the specimen with the
cancer in the middle and demonstrates
adequate macroscopic margins.
(c) shows a fully healed lateral
oropharygectomy defect.
• Robotic assisted radical tonsillectomy: Mainly for Squamous
carcinoma of tonsil (T1 and T2)
• OPSCC
33. Thyroid Surgery
• Smaller cervical incisions
• Minimally invasive video-assisted thyroidectomy technique
• incision as small as 1.5 cm.
• Developed noncervical incisions
• Endoscopic transaxillary surgeries
• -Disadv:- Technically difficult
• time intensive (3 to 4 hours to perform a lobectomy).
36. Selection criteria for robotic assisted thyroidectomy
Patient factors
• Highly motivated to
avoid cervical scar
• No morbid obesity
• No prior neck surgery
• ASA class 1 or 2
Disease factors
• Unilateral surgery
• Largest nodule ≤4 cm
• No thyroiditis
• No pathologic
lymphadenopathy
• No substernal extension
37. Complications of RATS
• Brachial plexopathies
• Tracheal and esophageal injuries
• Bleeding
• Unacceptable rate of recurrent laryngeal nerve injury.
38. The robotic facelift approach
• Postauricular skin crease- extension to the occipital hairline
Dissection- direction of the
sternocleidomastoid
Robotic facelift thyroidectomy: Incision
39. Advantage of Robotic facelift thyroidectomy
over RATS:
• No brachial plexopathy
• Shorter length of dissection
• Ability to stimulate the recurrent
laryngeal nerve
• Obese patients Positioning of robotic arms
41. Rhinology
• Sphenoid & Ethmoid sinus surgery
- Complication:-
- Intracranial damage
- Blindness
- Death
- Robot, A73
- Limited in case of sinus surgery
42. OTOLOGY
• Application of robotic surgery reported
- Mastoidectomy
- Stapes footplate micropick fenestration by Johns Hopkins SH robot
- Cochlear implant well drilling by RX130 Robot
43. Skull base surgery
• O'Malley et al excised a high parapharyngeal space mass with a
surgical robot in 2007.
- Descriptions of clinical applications- absent.
- Current robotic technology ??
- Fine instruments and drills- not available
- Future innovations.
44. CONCLUSION
• Continued to evolve
• Transoral and thyroid procedures
• Debatable : medical complications, economic, and ethical issue.
• The first otolaryngologic application of robotics occurred in 2002, with several reports from Terris and Haus -> explored endoscopic neck procedures.
• The first human application was described by McLeod and Melder in 2005 with a case report documenting the excision of a vallecular cyst with the robot.
The FDA has cleared the da Vinci Surgical System for use in urological procedures, general laparoscopic procedures, gynecological laparoscopic procedures, general thoracoscopic surgical procedures, thoracoscopically assisted cardiotomy procedures.
the daVinci ® Surgical System (Intuitive
Surgical Inc., Sunnyvale, CA) is the most popular plat-
form for robotic surgery. It consists of three parts: a
‘patient-side’ cart deploys surgical instruments placed
by the surgeon within the patient’s body including a bin-
ocular 12 mm endoscope with dual zero or thirty degree
optics, and a ‘surgeon’s console’ which is remotely placed
where three-dimensional surgical anatomy is recreated
and linked to instruments in a virtual environment. The
surgeon’s console consists of a three-dimensional display,
a seat for the surgeon, foot pedals to control cautery and
other instruments, and hand controls linked to instru-
ments placed in the operative feld. The three-dimensional
display affords the surgeon unprecedented perspective and
visualization of surgical anatomy along with the ability to
operate with 540 degrees of wristed instrumentation at
zero or thirty degree angles. Motion scaling increases pre-
cision by eliminating tremor and fatigue while also reduc-
ing greater hand movements. The ‘vision cart’ houses
the video processor and screens to project the procedure,
primarily used by the operating assistant and the other
observers.
To operate The Da Vinci surgical system
Surgeon sits at a console viewing a high definition 3D image inside the patient's body
The console is fitted with a glove like Apparatus that translates the surgeon's hand and finger movements into real time movements of the surgical instruments
The camera uses dual mounted endoscope that provide distinct views to the right and left eyes which produce a truly 3D field of vision for the surgeon at the console
Both 0 degree and 30 degree endoscope with either 12mm or 8mm diameter are available
Motion scaling and tremor reduction-
large movement by the surgeon are translated into find moments of robotic instruments without tremor
This system utilizes passive robotic Technology such that the movement of instruments attached to the robotic arms replicate precisely the movement of the surgeon's hands
Instrument stabilization tremor control and motion scaling
Image guidance and stereotactic orientation of the surgical instrument
Binocular endoscopic vision
Open and microscopic procedure do not allow binocular vision
Endoscopic and laparoscopic- loss of 3D vision and depth perception
Telepresence and telemonitoring
Expenses: zeus and da vinci cost around $1.12 – 1.16 million
Size- instrument size is not small
Currently available size 8 mm and 10 mm diameter instrument
Loss of force feedback/haptics- loss of tactile perception
Spacious OR
With the initial success of robotic surgery in otolaryngology, it has been most intensively evaluated for the management of pharyngeal laryngeal thyroid and skull base diseases
Da Vinci Transoral comparis to standard trans oral resectionthere are three benefits:-
Binocular magnification at the surface of the resection allows:
-clearer visualization of tumor boundries
-vascular tissue
-aids accurate assessment of tumour margins.
2. The use of 'wristed' three-dimensionally mobile grasping and cutting instruments allows better resection of the tumour compared with direct transoral view.
This improves the accuracy of tumour resection and manipulation of the specimen and vessels, making the surgery easier to perform.
3. The 'robotic surgeon' operating through two hand controls allows the 'manual assistant' to grasp, cut, ligate and suction in the field simultaneously.
It would be very difficult for a standard transoral procedure to take place with four surgeons' hands working on the tongue base.
20 million adults in the United States suffer from OSA
The role of tongue base hypertrophy have either been ineffective or they carry the morbidity associated with open surgery.
TORS can potentially address the role of tongue base hypertrophy in OSA in minimally invasive fashion with improved efficacy and minimal morbidity.
Earlier minimally invasive approaches- use of smaller cervical incisions in thyroid surgery.
Later, minimally invasive video-assisted thyroidectomy technique,
-This technique can be performed through an incision as small as 1.5 cm.
-Developed noncervical incisions-removal of the thyroid gland (endoscopically)
Endoscopic transaxillary surgeries were performed.
-Disadv:- Technically difficult
time intensive (3 to 4 hours to perform a lobectomy).
Then concept of merging robotic technology with a totally endoscopic thyroid procedure
In 2005, the first successful robotic axillary thyroidectomy was reported as an insufflation based technique.
In 2009, gasless robot-assisted transaxillary surgery (RATS) that uses a fixed retractor system to maintain the operative pocket, thus eliminating the need for gas insufflation
-Facelift-type incision is used to approach the thyroid compartment from the postauricular skin crease with extension to the occipital hairline, and a fixed retractor system maintains the exposure during the procedure.
-The dissection is then carried along in the direction of the sternocleidomastoid
No risk of brachial plexopathy -position.
Shorter length of dissection
Ability to stimulate the recurrent laryngeal nerve
Perform the procedure in slightly obese patients due to the ease of raising the skin flaps.
Done for Sphenoid & Ethmoid sinus surgery
Complication:-
Intracranial damage
Blindness
Death
Robot, A73 by research team & includes drill, suction, irrigation.
Robotic surgery is limited in case of sinus surgery
O'Malley et al excised a high parapharyngeal space mass with a surgical robot in 2007.
more recent descriptions of clinical applications have been absent.
This likely reflects the fact that current robotic technology does not fully meet the needs of skull base surgery;
the fine instruments and drills required for these operations are not yet available.
However, with further instrument and robotic development, the skull base likely represents a rich environment for future innovations.
The application of surgical robotics in otolaryngology has continued to evolve since the first report in 2002.
Transoral and thyroid procedures are now regularly performed, and new uses are emerging.
The debate over the proper role of the robot continues, and robotic technology remains a complicated medical, economic, and ethical issue.
