A minimally invasive medical procedure is defined as one that is carried out by entering the body through the skin or through a body cavity or anatomical opening, but with the smallest damage possible to these structures.
Robotically-assisted surgery was developed to overcome the limitations of minimally-invasive surgery and to enhance the capabilities of surgeons performing open surgery. In the case of robotically-assisted minimally-invasive surgery, instead of directly moving the instruments, the surgeon uses one of two methods to control the instruments; either a direct telemanipulator or through computer control. A telemanipulator is a remote manipulator that allows the surgeon to perform the normal movements associated with the surgery whilst the robotic arms carry out those movements using end-effectors and manipulators to perform the actual surgery on the patient. In computer-controlled systems the surgeon uses a computer to control the robotic arms and its end-effectors, though these systems can also still use telemanipulators for their input. One advantage of using the computerised method is that the surgeon does not have to be present. but can be anywhere in the world, leading to the possibility for remote surgery.
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| da Vinci Robotic system at the 2012 Academy meeting |
The da Vinci senses the surgeon’s hand movements and translates them electronically into scaled-down micro-movements to manipulate the tiny proprietary instruments. It also detects and filters out any tremors in the surgeon's hand movements, so that they are not duplicated robotically. The camera used in the system provides a true stereoscopic picture transmitted to a surgeon's console.
Drs. Gregory S. Weinstein and Bert W. O'Malley, Jr. of the University of Pennsylvania School of Medicine's Department of Otorhinolaryngology: Head and Neck Surgery founded the world's first TransOral Robotic Surgery (TORS) program at Penn Medicine in 2004, where they developed and researched the TORS approach for a variety of robotic surgical neck approaches for both malignant and benign tumors of the mouth, voice box, tonsil, tongue and other parts of the throat. TORS has dramatically improved the way head and neck cancers are treated, by achieving complete tumour removal while preserving speech and swallowing. It is a game changer for the way oropharyngeal tumors will be treated in the years to come. Head and neck tumor treatments often involve a combination of surgery, radiation therapy, and chemotherapy. In many cases, surgery offers the greatest chance of cure; yet conventional surgery may require an almost ear-to-ear incision across the throat or splitting the jaw, resulting in speech and swallowing deficits for patients. In comparison, the minimally invasive TORS approach, which accesses the surgical site through the mouth, has been shown to improve long term swallowing function and reduce risk of infection while speeding up the recovery time. When compared to traditional surgeries, after their cancers have been removed successfully, patients have been able to begin swallowing on their own sooner and leave the hospital earlier. TORS outcomes are markedly improved when compared to standard chemotherapy, radiation or traditional open surgical approaches for oropharyngeal cancer.
Obstructive sleep apnea (“sleep apnea”) is a disorder in which the soft tissues of the throat collapse on inhalation during sleep, causing disruption in the normal breathing process. Uvulo-palato-pharyngoplasty has been used to treat the palatal and pharyngeal collapse component of OSA. Tackling the tongue base component of the collapse was not always successful. Now TORS has been employed to successfully reduce the tongue base with considerably less morbidity.
(TORS - Tongue base reduction)
Robotic surgery though the mouth is a safe and effective way to remove tumors of the throat and voice box, The preliminary study examined the outcomes of 13 head and neck cancer patients with tumors located in the region of the throat between the base of the tongue and just above the vocal cords, an area known as the supraglottic region. The study found that the use of robot-assisted surgery to remove these tumors through the mouth took about 25 minutes on average, and that blood loss was minimal -- a little more than three teaspoons, or 15.4 milliliters, on average, per patient. No surgical complications were encountered and 11 of the 13 patients could accept an oral diet within 24 hours. If, on the other hand, these tumors are removed by performing open surgery on the neck, the operation can take around 4 hours to perform, require 7 to 10 days of hospitalization on average and require a tracheostomy tube and a stomach tube, the researchers say.
As the rate of thyroid cancer continues to climb, doctors are urging patients to be more cautious about thyroid nodules, a common disorder that is responsible for a small but growing number of thyroid cancer cases. Until recently, the only way to remove nodules and rule out cancer was through surgery that required a five centimeter incision across the front of the neck.Today however, a new option exists that allows surgeons to access the neck through the armpit, allowing for a biopsy of tissue with no visible scar. The procedure, transaxillary robotic thyroid surgery, utilizes 3D cameras and specially designed robotic arms to create a small incision within the armpit, the mechanical arms work just like hands allowing the specialized surgeon to operate remotely with precise control and movements to remove suspicious nodules. The underarm area has fewer nerve endings than the anterior neck area, so there's less pain, no scarring on the neck, and the incision heals faster.
Georgia Health Sciences University surgeons successfully performed a robotic submandibular salivary gland excision through the face lift incision in the hairline. A facelift incision and robotics can help surgeons safely remove a portion of a diseased thyroid from some patients without the characteristic neck scar. "It is outpatient, it doesn't require a surgical drain and it has the advantage of no neck scar," said Dr. David Terris, Chairman of the GHSU Department of Otolaryngology-Head and Neck Surgery. The goal was a no-neck-scar technique that's as safe as conventional thyroidectomy, which involves an incision at the base of the neck to gain immediate access to the thyroid, the surgeons report in The Laryngoscope. The benefits for robotic thyroid surgery include shorter recovery period, less pain in neck following surgery and better preservation of the laryngeal nerves and the parathyroid glands.
Doctors at AIIMS claimed to have performed the first robotic surgery for throat cancer in India, in May 2011. The doctors from AIIMS had been to University of Pennsylvania Hospital, Philadephia, for training in TORS. Similar surgeries were performed at Manipal hospital, Bangalore.
Source:
1)Science Daily
2) Wikipedia
3) Penn Medicine, Dept of Otorhinolaryngology Head & Neck surgey website
4) U tube
4) U tube
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