Robotics in Oral and Maxillofacial Surgery Dr. Chirag Patil M.D.S in Oral and Maxilllofacial Surgery

1. Robotics In Maxillofacial Surgery
By- Dr. Chirag Patil

2. CONTENTS
• Introduction
• Navigation surgery
• Robotic Surgery
• History
• Indication
• Types of Robotic Surgery
• Applications in head and neck region
• Advantages
• Disadvantages
• Legal/ethical issue
• Conclusion

3. INTRODUCTION
oSurgical management of deformities in the
craniomaxillofacial region → Imaging modality
oAdvances in imaging techniques → treatment
outcomes and enhanced the success rate of surgical
procedures.

4. NAVIGATION SURGERY
It Allows direct access to specific targeted areas
through smaller incisions, thus making surgery less
invasive, reliable and reduce overall operation time.
…….Watanabe in 1987

5. Concept of
Navigation
surgery is similar
to a car or a
mobile phone
global positioning
system, surgical
navigation
continuously
tracks locations
of anatomic area
and displays them
on a monitor
before, during
and after
surgery

6. NAVIGATION / IMAGE GUIDED
SURGERY COMPONENTS

9. • “A powered computer-controlled manipulator with
artificial sensing that can be reprogrammed to move
and position tools to carry out a range of surgical task”.
What is robotic surgery ????

10. o Robotic surgery is a type of
minimally invasive surgery.
o “Minimally invasive” means that
instead of operating on patients
through large incisions, use
miniaturized surgical instruments
that fit through a series of
quarter-inch incisions.
o Main objective - Reduce or
eliminate the tissue trauma
traditionally associated with open
surgery.

11. Intraoral approach poses challenge-
o Illumination of the field
o Vascular control
o Tissue manipulation

12. WHY ROBOTIC SURGERY?

14. Minimally Invasive
Surgery
Surgical Rehearsal
Intra-operative navigation
Pre-operative
planning
Remote Surgery

15. History
• “Robotics” : derived from Greek word Slave Labour or Forced Labour.

16. • In 1920 >> Term Robot was coined in from Czech word
“ Rabota” meaning laborer
• In 1921 >> Introduced by the Playwrighter Karel Capek.
• In 1942>> Engelberg and George C. Devol >> first
commercial company >> Unimation (Universal Automation)
• Engelberg is called “Father of Robotics”
• In 1985 >> PUMA 560 >>> place a needle for a brain biopsy
using CT guidance
• In 1988 >> PROBOT >>> developed at Imperial College London
• In 1992 >> ROBODOC >>> hip replacement.
• In 1993 >> Automated endoscopic system for optimal
positioning (AESOP).
• In 1994 >> ZEUS Robotic Surgical System
• In 2000 >> Da Vinci Surgical System
• In 2002>> FDA approved >> Da Vinvi System

17. Types of Robotic Surgery Systems:
• Supervisory controlled robotic surgery system.
• Tele surgical system.
1.Da Vinci surgical system.
2.ZEUS robotic surgery system.
3.AESOP robotic surgery system.
• Shared control robotic surgery system.
• Cyber Knife System

18. SUPERVISORY CONTROLLED ROBOTIC SURGERY
SYSTEM

19. TELE SURGICAL SYSTEM

20. DA VINCI SURGICAL
SYSTEM

21. Da Vinci Standard
(1999)
Da Vinci STS system
(2006)
Da Vinci Si system
(2009)

22. SURGEON’S CONSOLE
o Optimal hand-eye
alignment
o Immersive 3D stereo
viewer
o Comfortable seat
o posture – ergonomic
o Motion scaling & tremor
reduction

23. o Endowrist instruments
o 3-4 robotic arms
o Interchangeable end
effectors

24. Inserted through a small incision
very tiny video camera
3-dimensional magnified view
projects to a television screen

25. ZEUS Robotic surgical system

26. Zeus robotic surgical system

27. AESOP ROBOTIC SURGICAL SYSTEM

28. SHARED CONTROL ROBOTIC
SURGERY SYSTEM

29. CYBER KNIFE

30. oAlternative to open surgery
oMcLeod and Melder 2005
oImproved vision,
o Greater ease of use,
o Less blood loss,
oFewer complication,
oBetter cosmetic result
oContraindicated in Tumour invading the mandible
Trans Oral Robotic Surgery

31. Indications for robotic
surgery in the head and neck region
(1) Therapeutic and selective neck dissection.
(2) Removal of head and neck neoplasms or cysts
(3) Obstructive sleep apnea syndrome (OSAS).
Tumors with jaw or internal carotid artery invasion are
not currently suitable for robot-assisted resection

32. Modified facelift incision.Retroauricular incision.

33. self-retaining retractor.

38. oSuperior functional recovery;
oHigher rates of negative margin,
o Recurrence-free survival,
o Disease-free survival,
o Lower risk of hemorrhage,
o Low dependency on gastrostomy tube,
o Tracheostomy tube dependence,

39. Maxillofacial Trauma
• Consists of two procedures:
Reduction and Fixation
• First, position of fracture segments
changes before and after reduction,
• Difficult to provide precise navigation.
•
• No appropriate resistance during the
fixation
• Lack of tactile and haptic feedback.

40. Obstructive sleep apnea
• Surgical treatments include >>
Tonsillectomy,
Uvulopalatopharyngoplasty
(UPPP), Reduction of the tongue
base, maxillomandibular
advancement, Hyoid suspension.
• Vicini et al. 2010 >> reported the
first application of TORS in the
resection of the BOT, combined
with conventional septoplasty,
UPPP.

41. • Weihe et al 2000>> Reconstruction of computer aided
fronto-temporal bone resection
• Terris et al 2002>> Efficiency for neck procedures
• Tamer Theodossy et al 2003>> Model surgery in orthognathics
• Hockstein et al 2007>> Feasibility in head and neck surgery
• O’Malley and colleagues et al 2007>> Base of tongue
(BOT) neoplasm resection
• Rahbar et al. 2007>> Described the application of TORS in five
pediatric patients with laryngeal cleft

42. • David Terries et al 2008>> Neck dissection and submandibular gland
resection
• Auranuch et al 2009>> First dental implants
• William I. Wei et al 2010 >> Nasopharyngeal carcinoma.
• Lewis et al.2010>> Demonstrated the feasibility of transaxillary
robotic thyroidectomy
• Ronal B. Kuppersmith et al 2011>> Thyroid gland removal
• Samuel A Dowthwaite et al 2011>> Head and Neck Malignancies,
(TORS )
• Rohan R Walvekar et al in 2011>> Resection of Bilateral Oral Ranulas

43. • Fatma Tulin Kayhan et al 2011>> Tongue based Adenoid Cystic
Carcinoma
• Indran Balasundaram et al 2011>> Reconstructed the complex
fractures, resection of oropharyngeal tumours, reconstruction,
and microvascular anastomosis
• Samuel Robinson et al 2012>> Performed the Robot assisted
volumetric tongue base reduction and pharyngeal surgery for
Obstructive sleep apnoea.
• Lin Yang et al 2014 >> Hairline approach >> Remove benign
tumours of the submandibular gland
• Kasim durmus et al 2014>> TORS appeared to be more effective in
the detection and diagnosis of unknown primary tumors than
conventional methods, including computed tomography, positron-
emission tomography and directed biopsies,

44. ADVANTAGES
o Less scarring
oFaster recovery time
o Tiny incisions
o 0% Transfusion rate
oShorter catheter time 5 vs. 14 days
o Immediate urinary control
o Significantly shorter return to normal activities ( 1-2
weeks )
oEqual Cancer Cure Rate
o Less post operative pain

45. In-Surgery
o Surgeons have enhanced view
o Easier to attach nerve endings
o Greater surgical precision
o Surgeons tire less easily
o Fewer doctors required in operating rooms
o No risk of transmission of diseases
o Smaller risk of infection
o Less anesthesia required
o Less loss of blood
o Overcome limitations of human wrist

46. DISADVANTAGES
oQuestion of Safety
o Unproven Benefit
o Cost

47. Legal/Ethical issue in Robotic
surgery
o Time lag between surgeons commands and action of
robot could harm the patient
o Loss of power in an electrical failure
o Robotics does not replace human intelligence, skill
and experience
o• Surgicals Robots are much costlier

48. Conclusion
Robotic surgery may reduce operative morbidity,
hospital stay and recovery while potentially
improving clinical outcomes.

49. References
o Hang-Hang Liu et al 2007, Robotic surgical systems in
maxillofacial surgery: a review, International Journal of
Oral Science (2017) 9, 63–73
o Etern S. Park et al, Robotic Surgery, A New Approach to
Tumors of the Tongue Base, Oropharynx, and
Hypopharynx, Oral Maxillofacial Surg Clin N Am 25 (2013)
49–59
o Yoon Woo Koh et al, Robotic Approaches to the Neck,
otolaryngol Clin N Am 47 (2014) 433–454
o Avi Bansal et al,Robots in Head and Neck Surgery ,
Journal of Applied Dental and Medical Sciences NLM ID:
101671413 ISSN:2454-2288 Volume 2 Issue 1 January -
March 2016

50. Thank you