Dan Curricula - Hi I'm Dan Curricula, I'm at Eastern Virginia Medical School. I'm a professor of adolescent biology head and neck surgery Norfolk, Virginia. And I'm here to talk a little bit more about the center even miss comprehensive head and neck cancer program, specifically the Med robotics robot and what it can help us to do for our patients. Dan Curricula - The flex robot allows us to access the tongue based super athletic larynx, the oral pharynx areas that we have a little bit more trouble getting to what's standard equipment, whether it be micro direct Lauren gossipy, laser devices, the Vinci, rigid armed robot. The retractor systems in place teeth a guarded now we're bringing that flex robot arm in place. We have a side stand male stand is clamped down to or a bed it moves up and down with the bed. Which is an important safety feature I think for these sorts of cases. Those are the working channels there are those metal devices those side arms. Once we have that we have adequate exposure will bring the robot in further again taking care for access. And we'll drive the robot in with fine movements just its visualization, positioning, and we're at the head of the bed which is different than a Vinci robot where you're remote. It's something that's more comfortable with head neck and ordering all of you surgeons. And so we're starting to see this tumor at the right area pancreatic fold medial wall pure form you can see the pulsations from the carotid artery. And post a lateral right side introducing the instruments. You have bobby and have Maryland sector to retract and this is the Maryland sector retractor on the left side and a endotracheal tube obviously right there in the larynx introducing the bobby now. This is a needle to Bobby so it's quite fine the tip is really delicate and we have to be careful with the FIO two we have to be careful with Bobby sparks to that tube but because the movements are pretty precise we can stay away from the tube. Grasping the tumor, there are different blades for different exposure different access to the tongue base, oral pharynx, post your larynx sympathetic larynx hypo pharynx and this is really a diagnostic biopsy to retract. The endotracheal tube to the left side control all of tumor you get better exposure. You can see the initial cuts here. You can use a cut mode or cartridge mode with the bobby as you can with most bobby's. Less costly the better for a pathologist. We can Zoom in with the robot, we can adjust the intensity of the light, certainly we can adjust the end of the unit and bring it closer farther as well.
Dan Curricula - Nostrums extending along the right area of the reported medial well the piriformis. If there's any significant bleeding we can use Steiner clip a pliers or suction bobby or pressure. Cut noise with laser constrictors are also helpful along with a variety of from bye occasions flows heal etc. Since the time of this surgery we've done more advanced procedures we've done two supersonic Jack trans orally.
Dan Curricula - Rotate instrument they're wearing different exposure at different angles for the excision through the lateral border of this excision and depending on the specimen and the intent of the surgery you'll need to maintain orientation of the specimen for the pathologists margin assessment. This patient actually had to synchronous tumors, he also had a T1 Glock larynx cancer and this is an area pools it's a pure form tumor, so two tumors totally separate. Aquatic larynx cancer was on the left side this is a right sided leaving. There are also Michella Angela rangel instruments made for more delicate surgeries within the learned Earl and Troy this could be used. The anesthesia team also has a monitor so they can monitor the and watch the progress of the tumor excision and the procedure. The specimen would be withdrawn oriented submitted depending on the intent of the biopsy. So the flux robot is essentially a single arm unit allows me to get access to the back of the throat with a single arm, deploy the working instruments of bobby and Maryland the sectoral retractor and a place that I can't get to quite as easily with the differential.
