Emily K Funk, MD, Phillip Weissbrod, MD, Santiago Horgan, MD, FACS, Ryan Orosco, MD, Joseph Califano, MD. UC San Diego
Objective of the technology or device: We investigated a novel minimally-invasive surgical platform for its utility within the oropharynx and larynx for single-port natural orifice transoral surgery.
Description of the technology and method of its use or application: The preclinical investigational device by Fortimedix Surgical (Netherlands), features two ports for manually-controlled wristed articulating surgical instruments. A third port sits between the instrument ports and accepts both a rigid and flexible endoscope for visualization. The system is coupled to a Lindholm laryngoscope for oropharynx work and to a modified Jako laryngoscope for laryngeal access. In two cadaver head and neck models, we evaluated the surgical capabilities using flexible grasping instruments, microlaryngeal scissors, monopolar cautery, and sheath compatible with a laser fiber.
Preliminary results: Within the oropharynx, we found adequate strength, range of motion, and dexterity to perform lateral oropharyngectomy and tongue base resection using the flexible grasper and monopolar cautery.
Within the larynx, visualization was possible using a flexible endoscope, but was also adequate using a 0-degree and 30-degree rigid endoscope. The glottis, supraglottis, pyriform sinuses, post-cricoid space, and esophageal inlet were readily accessible. Visualization and manipulation of grasping, laser, and monopolar cautery instruments was also possible within the subglottis.
Instrument reach and accuracy allowed us to perform delicate micro-flap on the true vocal fold. This system also had the strength and dexterity to allow us to perform partial laryngeal resection. Other procedures included vocal fold resection, cricopharyngeal myotomy, and resection of subglottic mucosa.
Conclusions, future directions: From this initial experience, using the Fortimedix Surgical minimally-invasive platform, we found a wide-range of procedures within the oropharynx, larynx, and hypopharynx to be feasible. Further work is needed to evaluate its applicability to the clinical setting.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 98935
Program Number: ET009
Presentation Session: Emerging Technology Session
Presentation Type: Podium