Abstract
Introduction
Monopolar electrocautery is the most common dissection and coagulation tool during transoral robotic surgery (TORS) but causes significant collateral tissue damage as opposed to CO2 laser. We aimed at combining both modalities in one robotic instrument arm.
Methods
We developed a steerable CO2-laser fiber carrier serving as an add-on to the existing Endowrist® monopolar spatula of the Da Vinci Xi. Feasibility and safety were assessed in a preclinical setting.
Results
One radical tonsillectomy with monopolar cautery and 3 with the instrument prototype were performed in 2 cadavers by 2 surgeons. No serious prototype-related intra-operative difficulties were observed. Safe and efficient switching between energy sources proved possible in all simulated intra-operative bleeding events. Prototype use allowed for the identification of the majority of key anatomical structures and was scored favorably on NASA-TLX ques tionnaires.
Discussion
The reported prototype successfully combines the advantages of CO2-laser with the advantages of TORS.
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