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Computer Navigation, Planning, and

Robots in Otolaryngology

Jeremy D. Richmon, MD Associate Professor

Department of Otolaryngology - Head and Neck Surgery

Division of Head and Neck Surgery

Head and Neck Oncology

Microvascular Reconstruction

Robotic Surgery

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Disclosures

• Intuitive Surgical, Inc – previous

consultant

Otolaryngology – Head and Neck

Surgery

• Deals with the medical and surgical

treatment of ailments of the head and

neck, including: – Nose, Sinus, anterior skull base

– Larynx (speech/swallowing)

– Head and neck cancer

– Otology/neurotology (ear, lateral skull base)

– Allergy

– Facial Plastic Surgery

– Thyroid/Parathyroid

– Pediatric Oto

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Head and Neck Surgeon

• Lumps and bumps in head and neck

– Neoplastic

– Congenital

– Infectious

– Vascular

– Traumatic

• Airway and swallowing problems

• Reconstruction

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Head and Neck Surgery

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Congenital

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Infectious

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Vascular

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Traumatic

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Neoplastic

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OHNS Technology Driven Field

• Over past 30 years

– Endoscopy

– image-guidance

– Fiberoptic lasers

– Radiofrequency

– Microscopic instrumentation

– Plates/screws

– Imaging techniques (CT, MR, PET)

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Thyroid Surgery

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Parotid Surgery

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Sinus/skull base surgery

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History

• In 1985 a robot, the PUMA 560 (Programmable Universal Machine for Assembly), was used to place a needle for a brain biopsy using CT guidance.

• In 1988, the PROBOT, developed at Imperial College London, was used to perform prostate surgery.

• The ROBODOC from Integrated Surgical Systems was introduced in 1992 to mill out precise fittings in the femur for hip replacement.

Robot vs Surgeon

• Limit to human perception and dexterity

• Technology with a higher degree of

accuracy than humans allows for

continued progress and surgical

success.

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AESOP

• The first robotic applications to gain clinical acceptance was Automated Endoscopic System for Optimal Positioning (AESOP), a robotic arm for endoscopic camera control.

• AESOP was coupled with the Hermes voice-activation system to allow endoscope control by voice command.

• Food and Drug Administration (FDA) approval in 1993.

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Zeus

Used 3 modified AESOP arms

Initial testing at JHU 1996

Master-slave robot

versus

Active robot

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• NASA, Stanford, Military, Civilian

licence -> Intuitive, Inc.

• In 1997 a prototype of the DaVinci was

used to perform a lap chole

• In 2000 the DaVinci was FDA approved

for laparoscopic abd surgery

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DaVinci

• FDA approved for use in urological surgical

procedures, general laparoscopic surgical

procedures, gynecologic laparoscopic

surgical procedures, transoral otolaryngology

surgical procedures restricted to benign and

malignant tumors classified as T1 and T2,

general thoracoscopic surgical procedures,

and thoracoscopically assisted cardiotomy

procedures.

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Transaxillary Robotic Thyroidectomy

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Transoral robotic-assisted thyroidectomy: A preclinical feasibility

study in 2 cadavers.

Richmon JD, Pattani KM, Benhidjeb T, Tufano RP.

Head Neck. 2010 Jul 13.

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Drawbacks

• Cost

• Equipment/Space

• Learning curve

• Training and credentialing

• Lack of access (patients and anatomy)

• No tactile feedback (yet)

Larynx – Ear - Micro

• Steady Hand

– Tremor-free

– Scaled movements

– Force sensor

– Movement limits

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Challenge

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Limitations

• One-handed surgery

• Line-of-site limitations

• Rigid scope not paired with vision

• Cumbersome

• Narrow field of view

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Robo-ELF scope

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