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UC San Diego Health Flexes New Robotic Surgical Capabilities

System mimics surgeons’ hand movements, enhances performance

By Jeanna Vazquez   |   August 13, 2020

​Surgeons at UC San Diego Health were the first in California to use a new flexible robotic system for operations in two highly intricate areas of the body: the neck and throat. Using an articulated telescope, combined with a flexible instrumentation and a high-definition 3D vision system, the robotic system provides safe access to delicate anatomical regions, such as the tonsils, base of the tongue, lower portions of the throat and around and inside the larynx or voice box.

“This flexible robotic system is used across a range of applications, including tumor resection, sleep surgery and micro-laryngeal surgery,” said Charles Coffey, MD, board-certified otolaryngologist and head and neck surgeon at UC San Diego Health. “With this new technology, we’ll continue UC San Diego Health’s advances in minimally invasive surgical approaches.”

Medtronic flexbot

The new flexible robotic system at UC San Diego Health.

Performing surgery in tight, complicated areas of the human body, such as the neck and throat, can be very difficult using conventional, rigid instruments where navigating angles are critical. The system, manufactured by Medrobotics, allows surgeons to not only access critical structures through a single entry point, but also avoid vital structures, such as cranial nerves involved in speech and swallowing, movement of the face, tongue, neck shoulder, arm and diaphragm, as well as a large vessels transporting blood to and from the face and brain.

“The visualization of the ‘interior’ anatomy of the throat and voice box that can be achieved with a surgical robotic platform and binocular 3D cameras is really extraordinary,” said Coffey. “The high-definition, magnified view is what one might imagine seeing on a ‘Magic School Bus’ tour of the upper aerodigestive tract.”

The aerodigestive tract encompasses the combined organs and tissues of the respiratory tract and upper part of the digestive tract, including the lips, mouth, tongue, nose, vocal chords and parts of the esophagus and trachea.

Surgeons with UC San Diego Health began using the system in February 2020.

“The instrument mimics the movement of our hands and how we advance the robotic arm with a camera in areas difficult to access,” said Joseph Califano, III, MD, board-certified otolaryngologist and head and neck surgeon at UC San Diego Health. “The ability to use any type of surgical platform for transoral (through the mouth) robotic surgery provides enormous benefit to patients, including decreased hospital stay, decreased recovery time and minimized risk using a less invasive approach.”

For patients with cancer, the technology will provide access to tumors located in hard-to-reach areas of the throat, which can translate into better ability for the surgeon to remove the tumor while avoiding surgical incisions in the neck or jaw.

In addition, some tumors may be effectively treated by surgery alone, or surgery combined with a reduced postoperative radiation, rather than requiring a full regimen of postoperative radiation or chemotherapy.

The system also has therapeutic applications for patients with sleep apnea and other surgeries near the vocal cords.

“For patients with sleep disorders, this technology allows us to perform procedures efficiently and safely, which is especially important when it comes to sleep apnea surgery,” said Paul Schalch Lepe, MD, board-certified otolaryngologist and sleep medicine specialist at UC San Diego Health. “This way we can minimize the time we’re pushing on the tongue and avoid swelling, which is a huge advantage for the patient and surgeon.”

Robot-assisted surgery offers measurable advantages over many comparable traditional surgical techniques, from better visibility for the surgeon to intuitive hand-eye coordination and improved stabilization. UC San Diego Health’s expertise in robot-assisted surgery spans multiple specialties and involves a team of 25 highly specialized surgeons.

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