The use of robotic surgery to approach ear, nose, and throat diseases in the field of head and neck surgery through the oral route is called "Transoral Robotic Surgery (TORC)". This new technological method, which is applied using the Da Vinci surgical platform, provides patients and surgeons with a safer and more effective surgical opportunity while also bringing many advantages together.
What is robotic surgery?
Robotic surgery is a technology developed to allow surgeons on Earth to intervene on astronauts in space, with the help of a computer-assisted electromechanical device located between the surgeon and the patient. Robotic surgery technology is a modern form of telemedicine, which involves remote surgical application with the aid of a robot. In robotic surgery, the surgical robot platform is used as an auxiliary tool, just like in endoscopic surgery, and the surgeon performs the surgery. It was first used in heart surgery in 1998 and has been widely used in abdominal surgery, urological surgery, and other fields since the 2000s. Its use in ear, nose, and throat and head and neck surgery was approved by the FDA in 2009.
What is Surgical Robot?
The Da Vinci surgical platform is the most commonly used system. This surgical robot
platform consists of three parts: the surgeon's console, master manipulators, and
the unit that includes the 3D view screen and foot pedals. In addition, there is a
patient-side unit where the robot's arms are placed on the patient for the surgery
to be performed and where the screen is located.
Special training and certification are required to perform robotic surgery. Robotic
surgery training is provided at specialized training centers with different training
programs for each specialty. Work is done on animals and cadavers during these
trainings.
The title of "Expert Robotic Surgeon" is given to surgeons who have performed more
than 50 successful robotic surgeries, indicating the surgeon's robotic surgery
experience.
What are the specialties where robotic surgery is used?
Urology, cardiac surgery, general surgery, thoracic surgery, gynecology, pediatric
surgery, and head and neck surgery are the most common areas where robotic surgery
is used.
Robotic Surgery Applications in ENT and Head and Neck Surgery
• Üroloji, kalp cerrahisi, genel cerrahi, göğüs cerrahisi, jinekoloji, çocuk cerrahisi, Kulak burun boğaz ve baş-boyun cerrahisi robotik cerrahinin en sık kullanılan alanlarıdır.
KBB ve Baş-Boyun Cerrahisinde Robotik Cerrahi Uygulaması
Robotic Ear, Nose, and Throat (ENT) surgeries are performed by placing robot arms
inside the oral cavity. Therefore, the method applied is defined as "Transoral
Robotic Surgery (TORS)" or "Transoral Robotik Cerrahi (TORC)" in Turkish.
Transoral robotic surgeries performed with the Da Vinci platform are carried out
through instruments attached to the robot arms. The tips of these instruments are
less than 1 cm and flexible. They can move in different planes and angles, similar
to a human wrist, and perform functions such as cutting, holding, and burning.
Robotic endoscopes, one of these instruments, provide a 3D and 16x magnified image.
Unlike the human hand, the Da Vinci robot is prevented from trembling in any way. It
provides a wider range of motion and a 3D perspective, enabling more precise
dissection in the surgical area. This allows for better differentiation between
vascular-nerve structures and healthy and diseased tissues. At the same time, it
enables minimally invasive surgery while preserving functions within clearer
boundaries.
What ENT surgeries can be performed with Da Vinci robotic surgery?
Transoral Robotic Surgery was initially defined for "Transoral Robotic Radical Tonsillectomy" for removing tonsil cancer and "Transoral Robotic Supraglottic Partial Laryngectomy" for cancerous tumors located in the upper part of the larynx. Subsequent studies have shown that the following organs and diseases can be approached with robotic surgery:
• Benign and malignant tumors, cysts, and cancers of the larynx
• Benign and malignant tumors of the tonsils
• Benign and malignant tumors of the tongue and tongue root
• Benign and malignant tumors of the nasopharynx, soft palate (velum), cheek, and
pharynx
• It can also be used in the surgical treatment of obstructive sleep apnea syndrome
and snoring with a multi-level robotic surgery approach, with very successful
results."
What are the advantages of Transoral Robotic Surgery over traditional open surgery?
In traditional approaches to ear, nose, throat, and head and neck surgery, incisions are made in the facial and neck skin for cases requiring cuts to the upper and lower jawbones. In robot-assisted surgery, no skin incisions are made. The procedure of creating a hole in the windpipe called "tracheotomy" is not necessary. In transoral robotic surgery, bleeding is minimal. Patients have a shorter hospital stay and can return to normal eating and speaking habits more quickly without any loss of function. Patients benefit from these advantages over traditional open surgery.
What are the advantages of robotic surgery over endoscopic surgery?
These advantages are usually technical. Robotic surgery enables the surgeon to perform the surgery more easily and skillfully, while also completing it in a shorter amount of time.
• The robot's tips, which can mimic a 5mm wrist and have even more range of motion,
can reach the most remote areas and perform the surgical procedure with
precision.
• The tips of the robot can move in 7 planes for 540 degrees of motion, while
endoscopic tools can only move in one plane.
• A filter used in robotic surgery prevents the surgeon's hand and instrument from
shaking, while shaking of the surgeon's hand is a serious problem in endoscopic
surgery.
• Robotic tools can bend and flex, while endoscopic tools are rigid and cannot
bend.
• Sutures can be placed in robotic surgery, but not in endoscopic surgery.
• 3D vision is available in robotic surgery, while endoscopic surgery has only 2D
vision.
• The surgical field is magnified 16 times in robotic surgery, while magnification
is not possible in endoscopic surgery.
• During endoscopic surgery, the surgeon can only use one hand since they have to
hold the endoscope, while in robotic surgery the surgeon can use both hands.
Additionally, the surgeon can use both hands to assist in the surgical field. This
allows the surgeon to place sutures and perform four different operations
simultaneously, shortening the operation time and allowing for procedures that are
not possible in endoscopic surgery.
What are the benefits of Da Vinci robotic surgery in the treatment of obstructive sleep apnea?How is it used?
bstructive sleep apnea occurs when the upper airway collapses at different levels
during sleep, particularly at the level of the tongue base and throat in patients
with severe apnea. Prior to robotic surgery, it was not possible to address these
areas with minimally invasive surgery. However, with robotic surgery, these
procedures can now be performed safely and successfully. For a successful outcome
and safe surgery, the surgeon must have experience in sleep surgery and expertise in
robotic surgery.
How is robotic surgery used in the treatment of laryngeal (throat) cancer?
Robotic surgery has many advantages in the treatment of early stage laryngeal
(throat) cancer that affects the upper part of the larynx (supraglottis) and vocal
cords (glottis). Laryngeal cancer surgery using the robotic approach can be
performed without creating a tracheotomy (an opening in the windpipe) and without
leaving a scar on the skin.
Patients with early stage laryngeal cancer, selected advanced stage disease, or
recurrent disease can recover more quickly and begin speaking and swallowing earlier
with robotic surgery. Robotic surgery can also be used safely for intervention in
early stage tumors..