The surgeon then places a retractor in the patient’s mouth to gain surgical exposure, selleck chemical and the 3 sterilely draped robotic arms are placed in surgical position (Figures (Figures22 and and33). Figure 2 Patient-side cart and robotic arms positioning. (Courtesy of Intuitive Surgical Inc., 2010.) Figure 3 Robotic arms positioning in the oral cavity. Laryngeal reconstruction in pediatric patient. (Courtesy of Dr. Rahbar, 2007.) 7. Clinical Applications of Robotic Surgery in the Otolaryngology and Head and Neck Surgery 7.1. Head and Neck Oncology (TORS) O’Malley Jr. et al. initiated the TORS studies in canine and cadaveric models [13, 22�C27] and applied the technique to clinical practice. In 2006, three patients underwent robot-assisted transoral tongue base resection in a prospective clinical trial .
In this study, the robot enabled the surgeons to easily identify the glossopharyngeal, hypoglossal and lingual nerves, as well as the lingual artery. One T1 and one T2 squamous cell (AJCC cancer staging ): two instances of squamous cell carcinoma (one T1 and one T2) were adequately resected with negative margins, good hemostasis, and no postoperative complications. The different retractor types were assessed first during the cadaveric part of the study, and then at the beginning of each procedure performed in patients. The FK retractor achieved the best (versus Crowe Davis and Dingman retractors) tissue exposure and retraction. The same group published another study in which robot-assisted tonsillectomy was performed on 27 patients with squamous cell carcinoma.
25 of the 27 patients had negative cancer margins and 26 of the 27 patients were able to swallow postoperatively . In 2007, Solares and Strome  described transoral carbon dioxide (CO2) laser robotic-assisted supraglottic laryngectomy in a 74-year-old woman with a large supraglottic tumor. Postoperatively, the patient was able to swallow by day five. The use of the carbon dioxide laser linked to the surgical robotic system allows more maneuverability of the instrument’s tips and improves beyond ��sight of beam�� limitations. In addition to tumor resection, robotic surgery can be used in the reconstruction of postresection defects. Mukhija et al. reported two cases of robotic-assisted free flap reconstruction in the oral cavity and oropharynx.
These studies highlight the improved visualization provided by RAS, avoiding the need to perform a mandibulotomy for access, thereby reducing morbidity and operative time . After preliminary studies assessing the feasibility of TORS for oncologic resection, a series of studies were performed to examine the functional outcomes of these procedures [8, 15, 32�C39]. Most GSK-3 studies primarily report on oropharyngeal and oral cavity cancer, however, there are also case series on hypopharyngeal and laryngeal malignancy treated with TORS. Failure due to suboptimal access has been reported.