Help or Hoopla?: Surgical robots can benefit otolaryngology

While clinical trials are still underway (the University of Pennsylvania is currently recruiting participants), Dr. Magnuson predicts that TORS for sleep apnea may someday be one of the most common robotic procedures in otolaryngology. “I think that application is going to be performed more in ENT than TORS for cancer, because there are a lot more patients with sleep apnea,” Dr. Magnuson said.

Because the da Vinci Surgical System is FDA approved for benign disease, TORS for sleep apnea is an approved use of the robot. However, Dr. Weinstein said, it’s recommended that the procedure “be done in research protocols.”

Training

Surgeons considering adopting robotic techniques should “demonstrate proficiency in performing the standard procedure,” Dr. Kuppersmith said.

Dr. Magnuson agrees. “It’s key that surgeons already perform minimally invasive surgery,” he said. “Learning to use the robot doesn’t teach you how to do the operation.”

Indeed, robotic training is multi-layered. Interested surgeons must learn the robotic controls; they must then learn how to control the robot in a corporeal setting. Intuitive Surgical, Inc., makers of the da Vinci Surgical System, prepares physicians for training with a “series of educational experiences that include web-based learning and inanimate work where you’re playing around with these little plastic pyramids and throwing hoops over them using the robot,” Dr. Weinstein said.

Robotic surgery is a team sport, so nurses, OR technicians and anesthesiologists are invited to robotic training sessions. “You’re not even next to the patient when you’re doing surgery, so it’s really important to have a consistent team,” Dr. Kuppersmith said. “You need a whole team of people who know how to operate the robot and how the procedure works.”

Cadaver and porcine labs come after surgeons are familiar with the robotic controls. Currently, there are only a few cadaver labs in the country teaching robotic techniques for otolaryngology: the University of Pennsylvania, the University of Alabama at Birmingham and the University of Texas MD Anderson Cancer Center. Experienced surgeons may also lead porcine labs. Real-time observation of robotic surgeries is an essential part of training. The entire surgical team should observe an experienced surgeon and team performing multiple robotic procedures.

Finally, surgeons perform the robotic procedure under the direct guidance of a trained surgeon. Typically, the trained surgeon travels to the home institution of the trainee; each medical facility sets its own requirements for how many operations must be proctored before the surgeon is allowed to perform the robotic procedure independently.