Feasibility and Safety of Transoral Robotic Surgery (TORS) Using the daVinci Xi System

Introduction:

Trans Oral Robotic Surgery (TORS) has become well established using the previous generations of the da Vinci Surgical System, since they have been approved for TORS by the FDA in December 2009. Its most sophisticated evolution to date, the Xi System, has been introduced in April 2014 and was granted CE-mark for head and neck procedures in Europe in May 2016, while it is yet to be cleared by the FDA in the United States for this kind of indications, as of December 2017.

Methods:

Unlike the previous da Vinci-generations, the Xi System is a completely new robotic platform featuring a different architecture and docking concept to its precedessors. In this cadaveric study, our goal was to evaluate its feasibility and safety for standard TORS procedures such as partial oropharyngectomy, hypopharyngectomy, supraglottic laryngectomy as well as total laryngectomy. The cadaveric procedures have been performed at the IRCAD in Strasbourg, France in 2016 and 2017.

Results:

The ten consecutive cadaveric dissections were all performed with 8 mm Endowrist-Instruments, being the only available instrument shaft size for the Xi System to date. All dissections have resulted in an en-bloc resection of the given anatomy in the oropharynx, hypopharynx and supraglottic larynx. The lack of 5 mm-instruments did not restrict dissection maneuverability in the oropharynx and was partially compensated by the thinner (8 mm) camera and narrower arms, but it resulted in more instrument conflicts and in a more frequent need for repositioning in the hypopharynx and larynx.

Conclusion:

Despite its massively improved vision, easier docking and narrower robotic arms, the Xi System will only match the dissection ease of that of the Si System, when the 5 mm instruments become available for the new platform.

Publication History

Publication Date:
18 April 2018 (online)