Vinci Robotic Surgical System Research Articles

Transoral robotic study of the vascular anatomy of the head and neck

We aimed to explore, highlight and accurately identify the vascular anatomy of the oropharynx, hypopharynx and supraglottis utilizing the transoral robotic perspective. This was a case series using anatomic studies of cadaveric specimens. The cadavers were injected with red- and blue-dyed silicone through the arterial and venous systems to define the macro- and microvasculature. Following injection of the specimen, a da Vinci robotic surgical system was engaged to perform a transoral dissection of the oropharynx, hypopharynx and supraglottic regions. Dissection was carried out under high-definition optics. Vascular structures were identified and followed to their terminal branches. We successfully performed transoral robotic dissections of five fresh frozen cadaveric human heads which had been injected with dyed silicone. The injection technique and use of a high-definition magnifying camera allowed us to visualize and identify the vasculature of the head and neck in a unique fashion. The cadaveric model provides an excellent educational tool to aid in training. Additionally, the use of this model and the transoral approach has allowed us to identify vessels which typically may not be visible on routine dissection. We believe this to be very relevant in training and improving performance for safe and bloodless transoral robotic surgery. To our knowledge this is the first study using the transoral robotic approach to examine the vascular anatomy of the oropharynx and larynx.

Comparison of the environmental impact of commonly used surgical approaches to hysterectomy

Objective: The Da Vinci Robotic Surgical System is the focus of ongoing research to assess its clinical utility and costs (Intuitive Surgical, Sunnyvale, CA). The impact of these procedures on the environment, however, has not been assessed. With hospitals consuming 9% of United States energy and contributing 6,600 tons of waste to landfills each day, we sought to investigate the sustainability of this new, technology-driven surgical modality.

En bloc resection of epiglottic tumors with transoral robotic approach - preliminary results

This study aimed to identify whether it would be possible to excise epiglottic laryngeal tumors en bloc with a transoral robotic approach (TORS), ensuring that basic principles of oncologic surgery are followed. TORS was performed on three patients at Umraniye Education and Research Hospital. All patients had T1 epiglottic tumors. Unilateral neck dissections were performed for node-positive patients (n = 2). Postoperative radiotherapy was administered to these two patients. None of the patients had positive surgical margins. The follow-up period on average was 14 months, no recurrences were observed in this follow-up period. Normal food intake was possible in all cases. Tracheostomy was not performed on any patient. No postoperative complications were observed. These preliminary results indicate that application of the da Vinci robotic surgical system for en bloc resection of supraglottic partial cancers is technically feasible and safe, with satisfactory oncological outcome and postoperative laryngeal function.

Key points of digestive tract anastomosis in pancreatic surgery assisted by da Vinci robotic surgical system

The da Vinci robotic surgical system has the advantages of three-dimensional vision and high degree of accuracy,flexibility and repeatability,which makes surgical procedures such as digestive tract anastomosis easier to conduct under minimally invasive conditions.In this article,the feasibility and principle of digestive tract anastomosis and the procedures of pancreaticojejunostomy and pancreaticogastrostomy by the da Vinci robotic surgical system are introduced,so as to improve the quality of anastomosis and reduce the incidences of postoperative complications.Compared with traditional laparotomy,da Vinci robotic surgical system simplified the surgical procedures and reduced the trauma,which is suitable for digestive tract anastomosis in pancreatic surgery.The method of pancreatic anastomosis should be selected in consideration of the condition of patients,surgical procedure and the experience of surgeons. Key words: Pancreatic diseases; Da Vinci robotic surgical system; Pancreaticojejunostomy; Pancreaticogastrostomy

Short-term efficacy of da Vinci robotic surgical system on rectal cancer in 101 patients

To investigate the feasibility and safety of da Vinci robotic surgical system in rectal cancer radical operation, and to summarize its short-term efficacy and clinical experience. Data of 101 cases undergoing da Vinci robotic surgical system for rectal cancer radical operation from March 2010 to September 2012 were retrospectively analyzed. Evaluation was focused on operative procedure, complication, recovery and pathology. All the 101 cases underwent operation successfully and safely without conversion to open procedure. Rectal cancer radical operation with da Vinci robotic surgical system included 73 low anterior resections and 28 abdominoperineal resections. The average operative time was (210.3±47.2) min. The average blood lose was (60.5±28.7) ml without transfusion. Lymphadenectomy harvest was 17.3±5.4. Passage of first flatus was (2.7±0.7) d. Distal margin was (5.3±2.3) cm without residual cancer cells. The complication rate was 6.9%, including anastomotic leakage(n=2), perineum incision infection(n=2), pulmonary infection (n=2), urinary retention (n=1). There was no postoperative death. The mean follow-up time was(12.9±8.0) months. No local recurrence was found except 2 cases with distant metastasis. Application of da Vinci robotic surgical system in rectal cancer radical operation is safe and patients recover quickly The short-term efficacy is satisfactory.

OP101: Clinical outcomes of transoral robotic surgery for head and neck tumor

Purpose In order to reduce treatment-related morbidity and increase patients’ quality of life, robot-assisted surgery using the da Vinci surgical robotic system (Intuitive Surgical Inc., Sunnyvale, California) has been studied actively in the field of head and neck surgery. This study analyzes our experiences therewith in order to evaluate the feasibility and efficacy of robot-assisted surgery via a transoral approach in the head and neck area. Material and methods Between April 2008 and December 2011, 141 patients were treated with robot-assisted surgery via a transoral approach. Results Robot-assisted surgeries were successfully completed via a transoral approach in all patients. The mean robotic operative time was 69.3 min and that for the setting of the robotic system was 10.4 min. The average blood loss during the operation was 29.6 (range, 0–300 ml). Patients who received robot-assisted surgery were satisfied with good cosmetic results and treatment outcomes. Conclusions Robot-assisted surgery via a transoral approach was confirmed to be feasible and efficient in the field of head and neck surgery. Further research is needed to investigate the long-term functional and oncologic results of robot-assisted surgery.

Feasibility and Safety of Robotic Distal Ureterectomy

Abstract Introduction: The benign ureteral stricture disease and the urothelial carcinoma of the distal ureter can be managed by distal ureterectomy and ureteral reimplantation. The da Vinci robotic surgical system has been increasingly used in the management of a variety of urologic diseases. To assess the application of robotic surgery in the management of the distal ureter, we evaluated the feasibility and safety of robotic distal ureterectomy (RDU). We highlight our surgical technique with a surgical video. Materials and Methods: Nineteen patients with benign or malignant disease involving the ureter were enrolled between June 2004 and March 2012. Preoperative, intraoperative, and postoperative parameters were recorded and analyzed. The modified Clavien system was used to grade postoperative complications. Results: Ten patients underwent RDU for urothelial carcinoma of the distal ureter, and the other nine for benign stricture disease or iatrogenic injury. The median age at surgery was 65 years (inter...

The da Vinci Robotic Surgical Assisted Anterior Lumbar Interbody Fusion

Technique development to use the da Vince Robotic Surgical System for anterior lumbar interbody fusion at L5-S1 is detailed. A case report is also presented. To evaluate and develop the da Vinci robotic assisted laparoscopic anterior lumbar stand-alone interbody fusion procedure. Anterior lumbar interbody fusion is a common procedure associated with potential morbidity related to the surgical approach. The da Vinci robot provides intra-abdominal dissection and visualization advantages compared with the traditional open and laparoscopic approach. The surgical techniques for approach to the anterior lumbar spine using the da Vinci robot were developed and modified progressively beginning with operative models followed by placement of an interbody fusion cage in the living porcine model. Development continued to progress with placement of fusion cage in a human cadaver, completed first in the laboratory setting and then in the operating room. Finally, the first patient with fusion completed using the da Vinci robot-assisted approach is presented. The anterior transperitoneal approach to the lumbar spine is accomplished with enhanced visualization and dissection capability, with maintenance of pneumoperitoneum using the da Vinci robot. Blood loss is minimal. The visualization inside the disc space and surrounding structures was considered better than current open and laparoscopic techniques. The da Vinci robot Surgical System technique continues to develop and is now described for the transperitoneal approach to the anterior lumbar spine. 4.

Full robot-assisted gastrectomy with intracorporeal robot-sewn anastomosis produces satisfying outcomes

To evaluate the feasibility and safety of full robot-assisted gastrectomy with intracorporeal robot hand-sewn anastomosis in the treatment of gastric cancer. From September 2011 to March 2013, 110 consecutive patients with gastric cancer at the authors' institution were enrolled for robotic gastrectomies. According to tumor location, total gastrectomy, distal or proximal subtotal gastrectomy with D2 lymphadenectomy was fully performed by the da Vinci Robotic Surgical System. All construction, including Roux-en-Y jejunal limb, esophagojejunal, gastroduodenal and gastrojejunal anastomoses were fully carried out by the intracorporeal robot-sewn method. At the end of surgery, the specimen was removed through a 3-4 cm incision at the umbilicus trocar point. The details of the surgical technique are well illustrated. The benefits in terms of surgical and oncologic outcomes are well documented, as well as the failure rate and postoperative complications. From a total of 110 enrolled patients, radical gastrectomy could not be performed in 2 patients due to late stage disease; 1 patient was converted to laparotomy because of uncontrollable hemorrhage, and 1 obese patient was converted due to difficult exposure; 2 patients underwent extra-corporeal anastomosis by minilaparotomy to ensure adequate tumor margin. Robot-sewn anastomoses were successfully performed for 12 proximal, 38 distal and 54 total gastrectomies. The average surgical time was 272.52 ± 53.91 min and the average amount of bleeding was 80.78 ± 32.37 mL. The average number of harvested lymph nodes was 23.1 ± 5.3. All specimens showed adequate surgical margin. With regard to tumor staging, 26, 32 and 46 patients were staged as I, II and III, respectively. The average hospitalization time after surgery was 6.2 d. One patient experienced a duodenal stump anastomotic leak, which was mild and treated conservatively. One patient was readmitted for intra-abdominal infection and was treated conservatively. Jejunal afferent loop obstruction occurred in 1 patient, who underwent re-operation and recovered quickly. This technique is feasible and can produce satisfying postoperative outcomes. It is also convenience and reliable for anastomoses in gastrectomy. Full robotic hand-sewn anastomosis may be a minimally invasive technique for gastrectomy surgery.

Deep Infiltrating Colorectal Endometriosis Treated With Robotic-Assisted Rectosigmoidectomy

Deep infiltrating pelvic endometriosis with bowel involvement is one of the most aggressive forms of endometriosis. Nowadays, robotic technology and telemanipulation systems represent the latest developments in minimally invasive surgery. The aim of this study is to present our preliminary results and evaluate the feasibility of robotic-assisted laparoscopic colorectal resection for severe endometriosis. Between September 2009 and December 2011, 10 women with colorectal endometriosis underwent surgery with the da Vinci robotic surgical system (Intuitive Surgical, Sunnyvale, CA, USA). We evaluated the following parameters: short-term complications, clinical outcomes and long-term follow-up, pain relief recurrence rate, and fertility outcomes. Extensive ureterolysis was required in 8 women (80%). Ovarian cystectomy with removal of the cystic wall was performed in 7 women (70%). Torus resection was performed in all women, with unilateral and bilateral uterosacral ligament resection in 1 woman (10%) and 8 women (80%), respectively. In addition to segmental colorectal resection in all cases, partial vaginal resection was necessary in 2 women (20%). An appendectomy was performed in 2 patients (20%). The mean operative time with the robot was 157 minutes (range, 90-190 minutes). The mean hospital stay was 3 days. Six patients had infertility before surgery, with a mean infertility time of 2 years. After a 12-month follow-up period, 4 women (67%) conceived naturally and 2 (33%) underwent in vitro fertilization. We show that robotic-assisted laparoscopic surgery for the treatment of deep infiltrating bowel endometriosis is feasible, effective, and safe.

Instrument Failures for the da Vinci Surgical System: a Food and Drug Administration MAUDE Database Study

Our goal was to analyze reported instances of the da Vinci robotic surgical system instrument failures using the FDA's MAUDE (Manufacturer and User Facility Device Experience) database. From these data we identified some root causes of failures as well as trends that may assist surgeons and users of the robotic technology. We conducted a survey of the MAUDE database and tallied robotic instrument failures that occurred between January 2009 and December 2010. We categorized failures into five main groups (cautery, shaft, wrist or tool tip, cable, and control housing) based on technical differences in instrument design and function. A total of 565 instrument failures were documented through 528 reports. The majority of failures (285) were of the instrument's wrist or tool tip. Cautery problems comprised 174 failures, 76 were shaft failures, 29 were cable failures, and 7 were control housing failures. Of the reports, 10 had no discernible failure mode and 49 exhibited multiple failures. The data show that a number of robotic instrument failures occurred in a short period of time. In reality, many instrument failures may go unreported, thus a true failure rate cannot be determined from these data. However, education of hospital administrators, operating room staff, surgeons, and patients should be incorporated into discussions regarding the introduction and utilization of robotic technology. We recommend institutions incorporate standard failure reporting policies so that the community of robotic surgery companies and surgeons can improve on existing technologies for optimal patient safety and outcomes.

Da Vinci Robot-assisted surgical system in general surgery

With the initiation of laparoscopic techniques in general surgery and a significant expansion of minimally invasive techniques in the last 20 years.However,some of the shortcomings of laparoscopic technology has limited it's surgical application.More recently,the da Vinci robotic surgical system further defined the ability of a roboticassist device to address limitations in laparoscopy.This in cludes a significant improvement in instrument dexterity,dampening of natural hand tremors,three dimensional visualization,ergonomics,and camera stability.As experiencewith robotic technology increased and its applications to advanced laparoscopic procedures have become more understood,more procedures have been performed with robotic assistance.We review the current status of da Vinci robotic technology and its applications in general surgical procedures. Key words: da Vinci Robot-assisted surgical system; Minimally invasive surgery; Laparoscope; General surgery

Thoracic Robotics at the Heart Hospital Baylor Plano: The First 20 Cases

A da Vinci Robotic Surgical System was purchased for The Heart Hospital Baylor Plano in fall 2011 and a program for robotic-assisted thoracic surgery commenced at the facility. Successive thoracic patients were offered and accepted a robotic-assisted operation. No patient was excluded because of age, height, weight, or comorbidities. The first 20 patients are summarized herein. Of the first 10 operations, only one was a lobectomy. As the program staff gained experience, seven of the latter 10 procedures were lobectomies. The average length of stay was 2.6 days (longest, 4 days). The average operating room time was 147 minutes overall and 200 minutes for lobectomies. The longest operating room time was 337 minutes in a patient who underwent a right middle lobectomy that was converted to a video-assisted thoracic surgery. Two patients developed atrial fibrillation, one of whom had a pacemaker and a history of paroxysmal atrial fibrillation. One patient developed a bronchopleural fistula on the first postoperative day, following a coughing episode. One patient was readmitted 6 days after hospital discharge with a pneumothorax, which was successfully treated with a small-bore catheter. In conclusion, robotic-assisted thoracic surgery has many advantages. Decreased complications can lead to improved outcomes, and hospitals can achieve cost savings as a result of reduced length of stay.

Robotic Liver Resection for Colorectal Cancer Metastases: A Feasible and Safe Procedure

Introduction: This study employs a video on surgical techniques to present the author's experience in the use of the Da Vinci Surgical System in robotic hepatic resections.1 Description of the Video: 00:50—The patient is placed in a supine, reversed Trendelenburg position. A pneumoperitoneum is then created by introducing a Veress needle into the right hypochondrium. A 12-mm trocar, for the robotic camera, is positioned in the right paraumbilical region. The three 8-mm robotic ports are inserted, respectively, into the epigastrium, right hypochondrium, and left subcostal region. A 12-mm extra-port for accessory surgical instruments controlled by the assistant surgeon is placed at the umbilicus. 1:38—The exploration of the hepatic parenchyma reveals a repetitive hepatic lesion, approximately 40 mm in diameter, at segment VII protruding from the Glissonian. 2:40—The right lobe of the liver is mobilized by a section of the right coronary ligament. 3:05—The resection of hepatic segment VII can proceed, using ultrasonic scalpels, along the ischemic demarcation line, beginning at the anterior border of the liver. The exposure of the portion of parenchyma to be resectioned is obtained using polypropylene stitches placed at the left resection margins and used for traction by the instrument's fourth arm. 4:24—Hemostasis of any minor bleeding can be carried out using bipolar cautery, while major bleeds are dealt with using selective stitches of polypropylene 4/0. 6:12—A check is then carried out on the hemostasis and biliostasis. 6:30—Having completed the procedure, the operated section is extracted by means of an endocatch by slightly increasing the widening of the operational trocar access. 6:42—The Jackson drain will be positioned close to the slice of hepatic section. The disconnection of the robotic arms and deflation now take place. Finally, the mini-incisions are sutured. Materials and Methods: A 68-year-old man had previously undergone anterior rectal resection for cancer. During the oncology follow-up, computed tomography scan revealed the onset of a repetitive lesion in segment VII of the liver. A hepatic resection with the aid of the Da Vinci robotic surgical system was performed. The Da Vinci Surgical System is a telerobotic device controlled from a surgeon at remote console, while the surgical team is close to the operating table and follows the procedure through a service screen.2 Results and Conclusion: Estimated intraoperative bleeding was 90 mL, and no blood transfusions were necessary in the perioperative period. The operative time was 150 minutes. There was no postoperative morbidity, and the hospital stay was 3 days. The hystopathological examination of the portion of parenchyma removed (90 × 60 × 45 mm), perfectly contained the nodule measuring 45 × 31 mm with ample-free resection margins. This confirmed the radical solution of the robotic approach adopted. The follow-up was 18 months with disease-free survival. Even if comparative studies are necessary to demonstrate real advantages of the robotic approach with respect to classic laparoscopy, the Da Vinci Surgical System allows a large tridimensional field of view, a steady traction, tremor suppression, flexibility of the instruments, and offers improved dexterity with an internal articulated EndoWrist that permits seven degrees of freedom and therefore execution of precise and safe dissection of tissue and sutures.3,4 The authors state that none of the authors involved in the manuscript preparation has any conflicts of interest toward the manuscript itself, neither financial nor moral conflicts. Besides, none of the authors received support in the form of grants, equipment, and/or pharmaceutical items. Runtime of video: 7 mins

Optimal carbon dioxide insufflation pressure during robot-assisted thyroidectomy in patients with various benign and malignant thyroid diseases

BackgroundCurrently, data are not available concerning a safe insufflation pressure that provides a proper view of the surgical field without adverse metabolic and hemodynamic changes in humans undergoing the robot-assisted thyroidectomy bilateral axillo-breast approach (BABA) using the da Vinci robotic surgical system. The purpose of this study was to determine the optimal carbon dioxide (CO2) insufflation pressure in patients with various benign and malignant thyroid diseases when using the da Vinci robotic surgical system.MethodsA total of 32 patients underwent thyroid surgery at 6 (n = 15), 9 (n = 15), and 12 (n = 2) mmHg. The partial pressure of carbon dioxide (PaCO2), pH, cardiac output, heart rate, and mean arterial pressure were measured at baseline, 30 min and 1, 1.5, and 2 hours after CO2 insufflation, and 30 min after desufflation.ResultsCO2 insufflation of 12 mmHg caused severe facial subcutaneous emphysema, hypercarbia, and acidosis during robot-assisted thyroidectomy with BABA. The study was stopped before completion for the patients’ safety in accordance with the study protocol. Applying 6- or 9- mmHg of CO2 insufflation pressure caused increases in PaCO2 and decreases in arterial pH. However, vital signs were stable and pH and PaCO2 were within the physiologic range during the surgery in the 6- and 9-mmHg groups.ConclusionsWe propose that a CO2 insufflation pressure under 10 mmHg in robot-assisted thyroidectomy with BABA is the optimal insufflation pressure for patient safety.

Robot assisted prostate surgery using augmented reality with deformable models

We present preliminary results of our work to develop an augmented display for improved visualization of the prostate and surrounding critical anatomy for robot-assisted prostate surgery. Prostate cancer is the second leading cause of cancer-related deaths in men in the United States. Early stage prostate cancer is potentially cured by surgery, which can be performed in a traditional, open fashion or laparoscopically. Recently, robot-assisted laparoscopic radical prostatectomy (RALP) using the da Vinci surgical robot system has gained wide acceptance. Robotic systems improve surgeon dexterity by incorporating additional degrees of freedom at the end of the tools and offer increased precision and stability of movements. However, since the procedure is performed through small incisions, this technique reduces free sight and tactile feedback compared to open surgery. Surgeons also lose the ability to palpate the prostate to locate tumors and other critical structures such as neurovascular bundles (NVB). Surgeons must rely on visual cues from the video monitor and mentally correlate them with the underlying anatomy, often using information from medical images obtained prior to the procedure. Further complications arise from local deformations in the prostate tissue that occurs throughout the prostatectomy procedure due to the interaction between the surgical instruments and the prostate tissue. Subsequently, the anatomical model generated pre-operatively will need to be updated during the procedure to reflect this deformation. To address the clinical need for more accurate and reliable guidance, we are developing a navigation system that provides surgeons with an augmented reality (AR) view that fuses a pre-operative MRI model of the prostate, tumor and surrounding tissues with the da Vinci system laparoscopic video, while compensating for non-rigid prostate tissue deformation using intra-operative transrectal ultrasound (TRUS) imaging. The work focuses on three components: (i) Developing and evaluating algorithm for registration of MRI and ultrasound images (2) Building and testing an augmented reality, with 3D Slicer, Surgical Assistant Workstation (SAW) and the da Vinci surgical robotic system. (3) Evaluate the system using a multi-modality prostate phantom.

Robotic radical hysterectomy: Initial experience with the “da Vinci Robotic surgical system”

Robotic radical hysterectomy: Initial experience with the “da Vinci Robotic surgical system”

Objective assessment in residency‐based training for transoral robotic surgery

To develop a robotic surgery training regimen integrating objective skill assessment for otolaryngology and head and neck surgery trainees consisting of training modules of increasing complexity leading up to procedure-specific training. In particular, we investigated applications of such a training approach for surgical extirpation of oropharyngeal tumors via a transoral approach using the da Vinci robotic system. Prospective blinded data collection and objective evaluation (Objective Structured Assessment of Technical Skills [OSATS]) of three distinct phases using the da Vinci robotic surgical system in an academic university medical engineering/computer science laboratory setting. Between September 2010 and July 2011, eight otolaryngology-head and neck surgery residents and four staff experts from an academic hospital participated in three distinct phases of robotic surgery training involving 1) robotic platform operational skills, 2) set up of the patient side system, and 3) a complete ex vivo surgical extirpation of an oropharyngeal tumor located in the base of tongue. Trainees performed multiple (four) approximately equally spaced training sessions in each stage of the training. In addition to trainees, baseline performance data were obtained for the experts. Each surgical stage was documented with motion and event data captured from the application programming interfaces of the da Vinci system, as well as separate video cameras as appropriate. All data were assessed using automated skill measures of task efficiency and correlated with structured assessment (OSATS and similar Likert scale) from three experts to assess expert and trainee differences and compute automated and expert assessed learning curves. Our data show that such training results in an improved didactic robotic knowledge base and improved clinical efficiency with respect to the set up and console manipulation. Experts (e.g., average OSATS, 25; standard deviation [SD], 3.1; module 1, suturing) and trainees (average OSATS, 15.9; SD, 3.9; week 1) are well separated at the beginning of the training, and the separation reduces significantly (expert average OSATS, 27.6; SD, 2.7; trainee average OSATS, 24.2; SD, 6.8; module 3) at the conclusion of the training. Learning curves in each of the three stages show diminishing differences between the experts and trainees, which is also consistent with expert assessment. Subjective assessment by experts verified the clinical utility of the module 3 surgical environment, and a survey of trainees consistently rated the curriculum as very useful in progression to human operating room assistance. Structured curricular robotic surgery training with objective assessment promises to reduce the overhead for mentors, allow detailed assessment of human-machine interface skills, and create customized training models for individualized training. This preliminary study verifies the utility of such training in improving human-machine operations skills (module 1), and operating room and surgical skills (modules 2 and 3). In contrast to current coarse measures of total operating time and subjective assessment of error for short mass training sessions, these methods may allow individual tasks to be removed from the trainee regimen when skill levels are within the standard deviation of the experts for these tasks, which can greatly enhance overall efficiency of the training regimen and allow time for additional and more complex training to be incorporated in the same time frame.

Robot‐Assisted Neck Dissection in Papillary Thyroid Cancer

Objective: Robot-assisted neck dissection (ND) in papillary thyroid carcinoma (PTC) patients with lateral neck metastasis was proven to be feasible. However, approaches for upper neck levels are restricted. Thus, we designed novel approach for robotic ND to cover upper neck levels in PTC patients using transaxillary and retroauricular (TARA) incisions. Method: Between January 2011 and October 2011, 11 patients underwent total thyroidectomy and comprehensive neck dissection using a da Vinci surgical robotic system via TARA incisions. Results: In all cases, successful comprehensive NDs via TARA incisions using robotic surgical system could be performed. Axis change of robot was unnecessary to align the robotic arms and endoscope for upper neck levels. Vital structures including major vessels and nerves were preserved. No perioperative complications were developed. The numbers of retrieved lymph nodes in robotic neck dissections were comparable with those in conventional neck dissections. Conclusion: A robotic ND via a TARA approach to PTC patients with cervical lymph node metastasis was performed successfully. This new approach provides advantages especially in the dissection of levels IIb and V. This is a useful, alternative approach for addressing cervical lymph node metastasis in selected cases of PTC. Long-term outcomes of robotic ND should be accumulated to determine the oncologic safety.

Robot-assisted thyroidectomy: early experience.

The numbers of thyroid surgeries have been increasing recently. Robot-assisted thyroidectomy allows for a better cosmetic outcome in comparison with conventional open thyroidectomy. We performed two robot-assisted endoscopic thyroidectomies by a gasless unilateral axillo-breast approach using the da Vinci surgical robot system. We performed right thyroid lobectomies in both patients. The pathologic reports were: micropapillary carcinoma without extracapsular invasion in patient 1 and a benign cyst in patient 2. The operation times were 165 minutes in patient 1 and 110 minutes in patient 2. No postoperative complications occurred. Regarding our early experience, robotic thyroidectomy using the gasless axillo-breast approach is a safe, feasible, and cosmetically good procedure.