Transoral robotic surgery: Supraglottic laryngectomy in a canine model

Objectives/Hypothesis. To develop a technique for computer enhanced robotic transoral supraglottic partial laryngectomy in the canine model. Study Design: Surgical procedure on the larynx in a canine model with a commercially available surgical robot. Methods: With use of the da Vinci Surgical Robot (Intuitive Surgical, Inc., Sunnyvale, CA), the supraglottic partial laryngectomy was performed on a mongrel dog that had been orotracheally intubated using general anesthesia. The videoscope and the 8 mm end-effectors of the robotic system were introduced through three ports, transorally. The surgical procedure was performed remotely from the robotic system console. The procedure was documented with still and video photography. Results: Supraglottic partial laryngectomy was successfully performed using the da Vinci Surgical Robot, with 8 mm instrumentation. The robotic system allowed for celerity and accuracy secondary to findings specific to the surgical approach, including excellent hemostasis, superb visualization of the operative field with expeditious identification of laryngeal submucosal soft tissue and skeletal landmarks, and multiplanar transection of tissues. In addition, the use of the robotic system also was found to have technical advantages inherent in robotic surgery, including the use of "wristed" instrumentation, tremor abolition, motion scaling, and three-dimensional vision. Conclusions: The da Vinci Surgical Robot allowed for successful robotic transoral supraglottic partial laryngectomy in the canine model. Key Words: Robotic, endoscopic, minimally invasive surgery, microsurgery, larynx, partial laryngectomy, laryngeal cancer, da Vinci, transoral robotic surgery (TORS).