The standard existing da Vinci surgical robot (the Si model) has been much maligned for not being optimally designed for transoral access and endoscopic manoeuvrability in head and neck surgery. This preclinical work from Holsinger and his team looks at the feasibility of the new da Vinci Sp system in robotic hypopharyngectomy, an area which posed particular difficulty with the current robotic systems due to the complex pyramidal anatomy in that region. The new Sp model has been approved in the US for genitourinary surgery only. This study compares the Si and Sp systems directly in terms of visualisation, access and difficulty of dissection. The Sp model has flexible and smaller arms, a third grasping forcep, and a flexible endoscope. It has ‘joggle-joints’ which allow improved instrument manipulation in the confined space of the hypopharynx. This complements the existing seven degrees of movement. The authors concluded from their study on three cadavers that the new Sp robot offers the advantage of requiring less mouth-opening than required by the standard Si arms, and improved exposure of the surgical field. They also report that the technology and position of the new camera allows better visualisation which they propose will lead to better surgical resection. The disadvantage identified with the Sp was the large size of the monopolar tip in the delicate tissues of the hypopharynx. This paper does acknowledge that robotic advances are progressing in other ways at present, in particular the curved laryngoscope, and the ‘Flex’ endoscopic surgical system (Medrobotics). This is certainly an interesting time for technical advances in transoral robotic head and neck surgery. 

Flexible next-generation robotic surgical system for transoral endoscopic hypopharyngectomy: a comparative preclinical study.
Tateya I, Koh YW, Tsang RK et al.
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Aileen Lambert

Great Ormond Street Hospital, London, UK.

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