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      Robotic Surgery – Who is The Boss?

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      1
      Laryngo- Rhino- Otologie
      © Georg Thieme Verlag KG
      robotic, TORS, head and neck cancer, costs, clinical studies

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          Abstract

          In the head and neck region, great potential is seen in robot-assisted surgery (RAS). Mainly in cancer surgery, the use of robotic systems seems to be of interest. Until today, two robotic systems (DaVinci® und FLEX®) have gained approval for clinical use in the head and neck region, and multiple other systems are currently in pre-clinical testing. Although, certain groups of patients may benefit from RAS, no unbiased randomized clinical studies are available. Until today, it was not possible to satisfactorily prove any advantage of RAS as compared to standard procedures. The limited clinical benefit and the additional financial burden seem to be the main reasons, why the comprehensive application of RAS has not been realized so far.This review article describes the large variety of clinical applications for RAS in the head and neck region. In addition, the financial and technical challenges, as well as ongoing developments of RAS are highlighted. Special focus is put on risks associated with RAS and current clinical studies. We believe, that RAS will find its way into clinical routine during the next years. Therefore, medical staff will have to increasingly face the technical, scientific and ethical features of RAS.

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          Most cited references181

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          Continuum Robots for Medical Applications: A Survey

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            Transatlantic robot-assisted telesurgery.

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              Transoral robotic surgery (TORS) for base of tongue neoplasms.

              To develop a minimally invasive surgical technique for the treatment of base of tongue neoplasms using the optical and technical advantages of robotic surgical instrumentation. Ten experimental procedures including tongue base exposure and dissections were performed on three cadavers and two mongrel dogs. Transoral robotic surgery (TORS) was then performed on three human patients with tongue base cancers in a prospective human trial. Using the da Vinci Surgical Robot (Intuitive Surgical, Inc., Sunnyvale, CA), we performed a total of 10 base of tongue resections on edentulous and dentate cadavers as well as live mongrel dogs. In the cadaver models, exposure was evaluated using three different retractors, the Dingman, Crowe Davis, and FK retractors. The three human patients underwent TORS surgery of their tongue base cancers under an institutional review board approved prospective clinical trial. The ability to identify and preserve or resect key anatomic structures such as the glossopharyngeal, hypoglossal, and lingual nerves as well as techniques for identifying the lingual artery and achieving hemostasis were developed. The da Vinci Surgical Robot provided excellent visualization and enabled removal of the posterior one third to one half of the oral tongue in cadavers, dogs, and human patients. Among the three retractors evaluated, the FK retractor offered the greatest versatility and overall exposure for robotic instrument maneuverability. Complete resection to negative surgical margins with excellent hemostasis and no complications was achieved in the live patient surgeries. TORS provided excellent three-dimensional visualization and instrument access that allowed successful surgical resections from cadaver models to human patients. TORS is a novel and minimally invasive approach to tongue neoplasms that has significant advantages over classic open surgery or endoscopic transoral laser surgery.
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                Author and article information

                Journal
                Laryngorhinootologie
                Laryngorhinootologie
                10.1055/s-00000036
                Laryngo- Rhino- Otologie
                © Georg Thieme Verlag KG (Stuttgart · New York )
                0935-8943
                1438-8685
                March 2018
                22 March 2018
                : 97
                : Suppl 1
                : S231-S278
                Affiliations
                [1 ]Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Ulm
                Author notes
                Korrespondenzadresse Prof. Dr. med. Patrick J. Schuler Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum UlmFrauensteige 12D-89075 UlmTel.:+49-731-500-59501 , Fax:+49-731-500-59502 Patrick.Schuler@ 123456uniklinik-ulm.de
                Article
                lro4998095
                10.1055/s-0043-121791
                6541110
                29905359
                d9563720-8138-4d37-be54-821af3be5a1d

                This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License, which permits unrestricted reproduction and distribution, for non-commercial purposes only; and use and reproduction, but not distribution, of adapted material for non-commercial purposes only, provided the original work is properly cited.

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                robotic,tors,head and neck cancer,costs,clinical studies,robotik,kopf-hals-tumor,haptik,kosten,studien

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