Preclinical implementation of a steerable, Da Vinci Xi® compatible CO2-laser fibre carrier for transoral robotic surgery (TORS): A cadaveric feasibility study

Introduction Monopolar electrocautery is the most common dissection and coagulation tool during transoral robotic surgery (TORS) but causes significant collateral tissue damage as opposed to CO2 laser. We aimed at combining both modalities in one robotic instrument arm. Methods We developed a steerable CO2-laser fibre carrier serving as an add-on to the existing Endowrist (R) monopolar spatula of the Da Vinci Xi. Feasibility and safety were assessed in a preclinical setting. Results One radical tonsillectomy with monopolar cautery and three with the instrument prototype were performed in two cadavers by two surgeons. No serious prototype-related intra-operative difficulties were observed. Safe and efficient switching between energy sources proved possible in all simulated intra-operative bleeding events. Prototype use allowed for the identification of the majority of key anatomical structures and was scored favourably on NASA-TLX questionnaires. Discussion The reported prototype successfully combines the advantages of CO2-laser with the advantages of TORS