Jason Y K Chan1, Yoon W Koh2, Jeremy Richmon3, Jaewook Kim4, F Christopher Holsinger5, Lisa Orloff5, Angkoon Anuwong6. 1. Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Hong Kong, China. 2. Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, South Korea. 3. Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA. 4. Department of Otorhinolaryngology Head and Neck Surgery, Soonchunhyang University Hospital, College of Medicine, Seoul, South Korea. 5. Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University, Palo Alto, California, USA. 6. Department of Surgery, Police General Hospital, Faculty of Medicine, Siam University, Bangkok, Thailand.
Abstract
BACKGROUND: Transoral endoscopic thyroidectomy provides access via the oral vestibule and gas insufflation to provide reliable remote access surgery to perform a total thyroidectomy. The da Vinci SP (Intuitive Surgical Inc., Sunnyvale, CA, USA) is a next generation flexible single port system that offers unique advantages over previous robotic rigid systems. Here we sought to evaluate the feasibility of performing transoral thyroidectomy with this next generation flexible robotic system. METHODS: Cadaveric dissection with gas insufflation to test the feasibility of performing transoral thyroidectomy with the da Vinci SP. RESULTS: A 2 cm incision was made in the oral vestibule and the working space created with a 1cm central port and two lateral 5 mm ports. Then an extra small wound protector (Applied Medical, Rancho Santa Margarita, CA) was placed through the central incision after closure of the 5 mm ports. The robotic system was then deployed through the wound protector while insufflation was maintained at ~6 mmHg. Three instrument arms were deployed. A fenestrated bipolar was used to grasp the thyroid gland while Maryland bipolars and monopolar scissors were used to mobilize each hemi lobe of the thyroid. The recurrent laryngeal nerves were seen and preserved bilaterally. After completion of the surgery and removal of the wound protector the vestibular incision was measured to be 3 cm. Further dissection to identify the mental nerves identified each nerve to be >1 cm from the lateral extent of the central incision. CONCLUSIONS: In summary, it is feasible to perform a total thyroidectomy with gas insufflation utilizing this next generation flexible robotic system. Further evaluation will be needed to validate the clinical applicability of this technique. 2019 Gland Surgery. All rights reserved.
BACKGROUND: Transoral endoscopic thyroidectomy provides access via the oral vestibule and gas insufflation to provide reliable remote access surgery to perform a total thyroidectomy. The da Vinci SP (Intuitive Surgical Inc., Sunnyvale, CA, USA) is a next generation flexible single port system that offers unique advantages over previous robotic rigid systems. Here we sought to evaluate the feasibility of performing transoral thyroidectomy with this next generation flexible robotic system. METHODS: Cadaveric dissection with gas insufflation to test the feasibility of performing transoral thyroidectomy with the da Vinci SP. RESULTS: A 2 cm incision was made in the oral vestibule and the working space created with a 1cm central port and two lateral 5 mm ports. Then an extra small wound protector (Applied Medical, Rancho Santa Margarita, CA) was placed through the central incision after closure of the 5 mm ports. The robotic system was then deployed through the wound protector while insufflation was maintained at ~6 mmHg. Three instrument arms were deployed. A fenestrated bipolar was used to grasp the thyroid gland while Maryland bipolars and monopolar scissors were used to mobilize each hemi lobe of the thyroid. The recurrent laryngeal nerves were seen and preserved bilaterally. After completion of the surgery and removal of the wound protector the vestibular incision was measured to be 3 cm. Further dissection to identify the mental nerves identified each nerve to be >1 cm from the lateral extent of the central incision. CONCLUSIONS: In summary, it is feasible to perform a total thyroidectomy with gas insufflation utilizing this next generation flexible robotic system. Further evaluation will be needed to validate the clinical applicability of this technique. 2019 Gland Surgery. All rights reserved.
Authors: Jonathon O Russell; James Clark; Salem I Noureldine; Angkoon Anuwong; Mai G Al Khadem; Hoon Yub Kim; Vaninder K Dhillon; Gianlorenzo Dionigi; Ralph P Tufano; Jeremy D Richmon Journal: Oral Oncol Date: 2017-06-10 Impact factor: 5.337
Authors: Jason Y K Chan; Eddy W Y Wong; Raymond K Tsang; F Christopher Holsinger; Michael C F Tong; Philip W Y Chiu; Simon S M Ng Journal: Eur Arch Otorhinolaryngol Date: 2017-09-04 Impact factor: 2.503