This can lead to ripping of the tissue or the suture. This can be a significant problem early on, although the improvement in visualization is such that the surgeon rapidly learns visual clues to compensate for his lack Sunitinib FLT3 of feedback. Despite this, RAS still requires careful handling of tissues by the surgeon. 5.2. Equipment Size and Weight Increased physical space requirements in the operating room are needed to accommodate the large and heavy equipment. Additional time and personnel are needed to set it up, along with specialized training for OR staff. 5.3. Cost of the Device Initial installation cost ranges from 1.5 to 2.5 million dollars (US) depending on the model, along with an approximately 100,000 dollars annual maintenance fee and 2000 dollars per instrument (each instrument has a ten use lifespan); the da Vinci robotic system is one of the most expensive operating tools available, making it impractical for many institutions.

5.4. New Technology and Unproven Benefit Stronger studies are needed to assess the real cost-benefit of this technology compared to other techniques. 6. Surgical Set-Up The description below applies to the TORS procedures, although not all procedures in the head and neck region use this approach. (Other approaches are commented on in each procedure description.) Transoral Robotic Surgery (TORS) is defined as surgery performed via the oral cavity that uses a minimum of three robotic arms and allows bimanual manipulation of tissues [21]. It was first developed by Weinstein and O’Malley, who have assessed the feasibility of this technique using the da Vinci Robotic System [13, 22�C27].

To minimize obstruction and maximize the communication between the surgeon and his/her assistants in TORS surgery, the surgeon’s cart should be located at the end of the operating room, allowing free space to maneuver the surgical cart that is placed on the right side of the patient, opposite to the surgeon. The support staff and instrument carts are located on the side of the patient, opposite the surgeon as well. The anesthesia machine and anesthesiologist are at the patient’s foot (Figure 1). Anesthesia induction is usually done without moving the patient; this technique is described in detail by Chi et al. [28]. According to Chi et al., this method of organization slightly complicates the induction, but vastly simplifies setup for procedure, saving 15�C20 minutes per case.

Performing the induction across from the anesthesia unit does not require the disconnection/reconnection of IV lines, monitor devices, or the anesthesia circuit, avoiding entanglement with the robotic equipment. Next, with the patient in supine position, the airway is secured via standard endotracheal intubation and the tube is appropriately Drug_discovery secured. Safety goggles and a molded dental guard are used to protect the patient.