In 2006, three patients with tongue base tumors underwent TORS as part of prospective kinase inhibitor Ruxolitinib clinical trial by O’Malley Jr. et al. [13]. 3. The Current Robotic System At its core, the Intuitive Surgical Corporation system is a comprehensive master-slave arrangement, with the surgical robotic cart containing multiple manipulation arms that are operated remotely from a console. The robot contains video-assisted visualization and computer enhancement and is composed of three components: the surgical cart, the vision cart, and the surgeon’s console (Figure 1). Figure 1 Operation room setup (Courtesy of Intuitive Surgical Inc., 2010). The surgical cart (or slave unit) is equipped with four arms; one arm holds a 0�� or 30�� 12mm stereoscopic camera (with 2 optical channels, each 5mm), and the other three arms hold 5mm (pediatric size) or 8mm (conventional) EndoWrist instruments (Intuitive Surgical Inc.
), that are easily interchangeable by surgical staff according to the surgeon’s desire and procedure requirement. The vision cart is equipped with two light sources, an insufflator, and hardware that generates the three-dimensional image. The cart usually holds another monitor for the assistant surgeon. The surgeon’s console (or master unit) displays two images, one for each eye. This creates a 3-dimensional image that greatly improves depth perception within the surgical field. In addition, the console is the interface for the surgeon to control the instrument, by controlling the hand manipulators.
The surgeon’s console is equipped with pedals to control the camera and instrument arm clutching (disengagement of the hand controllers from the surgical arms) camera controller, focus adjustment, and electrocautery. There are also surgeon personalization and settings controls. The EndoWrist instruments are controlled by the surgeon at the master console and provide multiple degrees of freedom, including pitch, yaw, and roll plus two additional degrees of freedom in the wrist and two others for tool actuation��a total of seven degrees of freedom in all. This is in comparison to endoscopic instruments that have just 4 degrees [7]. 4. Advantages of Robot-Assisted Surgery 4.1. Enhanced Visualization The 3-dimensional visualization and tenfold magnification of the operative field enhance the depth of the field and the clarity of the tissue planes during dissection [14].
This can be especially helpful during head and neck surgery and pediatric surgery, because of the small size of the surgical field and the inability to maneuver the instruments and the camera within it. It can also help in distinguishing tissue types in oncological dissection [15]. 4.2. Elimination of Physiologic Tremors and Scale Motion Carfilzomib The surgical system eliminates the surgeon’s tremor through hardware and software filters.