Semin Plast Surg 2014; 28(01): 032-034
DOI: 10.1055/s-0034-1368165
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Robotic Approaches to Palatoplasty and the Treatment of Velopharyngeal Dysfunction

James M. Smartt Jr.
1   Department of Plastic Surgery, University of Texas Southwestern and Children's Medical Center, Dallas, Texas
,
Patrick Gerety
2   Division of Plastic Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
,
Jesse A. Taylor
2   Division of Plastic Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
› Author Affiliations
Further Information

Publication History

Publication Date:
07 March 2014 (online)

Abstract

The operative techniques used to address palatoplasty and velopharyngeal dysfunction rely on traditional methods of surgical exposure and tissue handling. As the role of robotic surgical systems has expanded, emphasis has shifted from extirpative to reconstructive applications. We discuss the possible role of surgical telemanipulation systems in the treatment of these diagnoses. Furthermore, we present a feasibility study that addresses a commonly performed treatment of velopharyngeal dysfunction—posterior pharyngeal flap (PPF). In brief, PPFs were successfully performed on a small series of cadaveric human specimens. The technical aspects of the procedure, including telemanipulator set-up, positioning, surgical instrumentation, and timing are described in detail. All cadavers underwent successful performance of PPFs. Operative times were within an acceptable range and use of the robotic system demonstrated a steep learning curve. Many of the potential advantages and costs associated with robotic surgical systems are discussed.

 
  • References

  • 1 Liau JY, Sadove AM, van Aalst JA. An evidence-based approach to cleft palate repair. Plast Reconstr Surg 2010; 126 (6) 2216-2221
  • 2 Katz RD, Taylor JA, Rosson GD, Brown PR, Singh NK. Robotics in plastic and reconstructive surgery: use of a telemanipulator slave robot to perform microvascular anastomoses. J Reconstr Microsurg 2006; 22 (1) 53-57
  • 3 Katz RD, Rosson GD, Taylor JA, Singh NK. Robotics in microsurgery: use of a surgical robot to perform a free flap in a pig. Microsurgery 2005; 25 (7) 566-569
  • 4 Smartt Jr JM, Singh DJ, Reid RR, Hellinger JC, Hsu VM, Bartlett SP. Squamosal suture synostosis: a cause of atypical skull asymmetry. Plast Reconstr Surg 2012; 130 (1) 165-176
  • 5 Mirzabeigi MN, Lee M, Smartt Jr JM, Jandali S, Sonnad SS, Serletti JM. Extended trimethoprim/sulfamethoxazole prophylaxis for implant reconstruction in the previously irradiated chest wall. Plast Reconstr Surg 2012; 129 (1) 37e-45e
  • 6 Fosnot J, Fischer JP, Smartt Jr JM , et al. Does previous chest wall irradiation increase vascular complications in free autologous breast reconstruction?. Plast Reconstr Surg 2011; 127 (2) 496-504
  • 7 Hassanein AH, Mailey BA, Dobke MK. Robot-assisted plastic surgery. Clin Plast Surg 2012; 39 (4) 419-424
  • 8 Bonawitz SC, Duvvuri U. Robotic-assisted FAMM flap for soft palate reconstruction. Laryngoscope 2013; 123 (4) 870-874
  • 9 Smartt Jr JM, Gerety P, Serletti JM, Taylor JA. Application of a robotic telemanipulator to perform posterior pharyngeal flap surgery: a feasibility study. Plast Reconstr Surg 2013; 131 (4) 841-845
  • 10 Selber JC, Robb G, Serletti JM, Weinstein G, Weber R, Holsinger FC. Transoral robotic free flap reconstruction of oropharyngeal defects: a preclinical investigation. Plast Reconstr Surg 2010; 125 (3) 896-900
  • 11 Johnson DE. International adoption: what is fact, what is fiction, and what is the future?. Pediatr Clin North Am 2005; 52 (5) 1221-1246
  • 12 Johnson DE. The family physician and international adoption. Am Fam Physician 1998; 58 (9) 1958-1963 , 1960, 1963
  • 13 Karamanoukian RL, Bui T, McConnell MP, Evans GR, Karamanoukian HL. Transfer of training in robotic-assisted microvascular surgery. Ann Plast Surg 2006; 57 (6) 662-665
  • 14 Karamanoukian RL, Finley DS, Evans GR, Karamanoukian HL. Feasibility of robotic-assisted microvascular anastomoses in plastic surgery. J Reconstr Microsurg 2006; 22 (6) 429-431
  • 15 Selber JC. Transoral robotic reconstruction of oropharyngeal defects: a case series. Plast Reconstr Surg 2010; 126 (6) 1978-1987
  • 16 Capone AC, Parikh PM, Gatti ME, Davidson BJ, Davison SP. Occupational injury in plastic surgeons. Plast Reconstr Surg 2010; 125 (5) 1555-1561