Improved Glottic Exposure for Robotic Microlaryngeal Surgery: A Case Series.

Robotic surgery has become the standard of care for many procedures outside of otolaryngology and now is gaining momentum within our specialty. The da Vinci (Intuitive Surgical, Sunnyvale, CA) robot has several advantages to human hands, including removal of tremor and better access to lesions because of increased degree of movement of the articulated instruments. The glottis has rarely been addressed using robotic surgery because access was previously thought to be difficult because of the limitations of currently used retractors, which include poor base of tongue and oral commissure retraction resulting in lack of exposure of the glottis in many patients and lack of space for the robotic instruments to occupy. We present a case series using the Modular Oral Retractor (MOR) system to show that the glottic larynx can be accessed by the da Vinci instrumentation. The MOR system provides better exposure of the anterior commissure and by using oral commissure retraction provides excellent space for the robotic arms to work. The MOR system potentially makes robotic microlaryngeal surgery more feasible for the otolaryngology-head and neck surgeon.