Sunday, 13 July 2014

Robotics in ENT

ENT Surgery had a revolution with introduction of nasal endoscopes in the late 80's.Since then, ENT Surgeons have expanded their horizon from nasal cavity to the base of skull.Presently endoscopes are also used for ear surgeries.
As surgeons we need to update ourselves with the latest techniques available & above all learn to use them.

Before adapting any technique in practice ,we go through rigorous training on cadavers.I remember attending 3-4 dissection courses per year for mastering the nasal endoscopic surgery & the hands on training still continues every year.Training & learning never stops as we expand our horizons.

Robotic in surgery has been there for a while now. The da Vinci Surgical System is a robotic surgical system made by the American company Intuitive Surgical. Approved by the Food and Drug Administration (FDA) in 2000, it is designed to facilitate complex surgery using a minimally invasive approach, and is controlled by a surgeon from a console.  

The main applications for Robotic surgery have been  in Urology,Gynecology & General surgery.The first Robotic set up came to India in January 2011. Vattikuti Technologies are the distributors in India for the da Vinci® surgical systems.  

Above picture depicts the latest Model. da Vinci Si HD. The surgeons at the console,the Robot at the patient table,scrubbed nurse for helping with instruments & the display tower
Recently I had the opportunity to a attend a training on the da Vinci Simulator organised by Vattikutti Technologies.It was a humble experience.The Vattikutti technologies are based in Bangalore & they offer these training sessions for surgeons.It starts with introductory videos & interactive session with their engineers.Then hands on with the robot stationed there.

There is a learning curve for this technology as with any new gadget.The most impressive things for me was the amazing "Endowrist" intrumentation (180 degree articulation & 540 degree rotation) The latest model in the first picture has two consoles ,useful for training as well TilePro is another plus as the surgeon can see  multisource videos in the same screen.

The application in ENT Surgeries has been mainly in oral cavity & neck.Procedures like  lingual tonsil excisions, tongue base resections & supraglottic resections have been performed so far. Case selection is very important.

Though it comes with set of instruments & forceps as ENT surgeons use it more ,we can modify instruments suitable for ENT use.For Pediatric ENT ,surgeons are working on smaller & flexible scopes.

The use of Robotics in ENT Surgery is new & indications are expanding.Cost effectiveness is a challenge at the moment.

I must finally thank Vattikutti Technologies & their team for the excellent insight in to robot handling and their hospitality.

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